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20-001 Mission Academy of Music, dba Melody Academy of Music
Rec Supervisor May 14, 2020 Rachelle Sander May 14, 2020 Exh. B Insurance for Recreation Contracts Updated Sept. 2019 1 As required by the Agreement, Contractor shall procure prior to commencement of Services and maintain the following insurance for the duration of the Agreement against claims arising from or in connection with Contractor, its agents, representatives, employees or subcontractors Services under this Agreement. Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an “occurrence” basis, including property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this project/location (CG 25 03 or 25 04) or be twice the required occurrence limit. a) It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b) Additional Insured coverage under Consultant's policy shall be "primary and non-contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13). c) The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary 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 0001 covering Code 1 (any auto), or if Contractor has no owned autos, Code 8 (hired) and 9 (non-owned), with limits no less than $1,000,000 per accident for bodily injury and property damage. Required if automobile is used to perform work under this contract. Otherwise, proof of Contractor’s personal auto insurance with limits required by state law suffices. Contractor shall not transport or use its personal vehicle to transport participants or perform work under this contract. 3. Workers’ Compensation: As required by the State of California, with Statutory and Employer’s Liability Insurance limits of no less than $1,000,000 per accident for bodily injury or disease. Required if Contractor has employees. If no employees, Contractor must sign Affidavit of No Employees. 4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/services involving minors, (i.e., after school activities, recreational programs, athletics, study/training events and transportation of minors). Coverage may be included under General Liability or be obtained in a separate policy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this contract or be twice the required occurrence limit. Required if Contract involves services to children. Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance. Exhibit B Insurance Requirements for Recreation Contracts Exh. B Insurance for Recreation Contracts Updated Sept. 2019 2 OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers (“Additional Insureds”) are to be covered as additional insureds on Consultant’s CGL and automobile liability policies. General Liability coverage can be provided in the form of an endorsement to Consultant’s insurance (at least as broad as ISO Form CG 20 10 (11/ 85) or both CG 20 10 and CG 20 37 forms, if later editions are used). Primary Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance maintained by City, its officers, officials, employees, or volunteers shall be excess of Consultant’s insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Waiver of Subrogation Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the extent said losses are covered by the insurance policies required herein. Specifically, the Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self-Insured Retentions Any deductible or self-insured retention must be declared to and approved by the City. At City’s option, either: the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the insured or the City. Acceptability of Insurers Insurers must be licensed to do business in California with an A.M. Best Rating of A-VII, or better. Verification of Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements (or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements prior to commencement of the Contract. City retains the right to demand verification of compliance at any time during the Contract term. Subconsultants Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant’s insurance policies. Higher Insurance Limits If Consultant maintains broader coverage and/or higher limits than the minimums shown above, City shall be entitled to coverage for the higher insurance limits maintained by Consultant. Adequacy of Coverage City reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD MISSI-3 OP ID: JS 03/11/2020 Brenda Aldaco Parra Insurance by Allied Brokers-1 Lic # 0525309 630 Cowper Street Palo Alto, CA 94301 Brenda Aldaco Parra 650-328-1000 650-324-1142 certs@alliedbrokers.com Markel Insurance Company Mission Academy of Music LLC A X 1,000,000 X X X 04/20/2020 04/20/2021 100,000 10,000 1,000,000 3,000,000 X 3,000,000 XX 1,000,000A 04/20/2020 04/20/2021 1,000,000 A 04/20/2020 04/20/2021 1,000,000 The holder of this certificate, The City of Cupertino, its City Council, boards and commissions, officers, officials, employees, agents, servants and volunteers, are to be covered as additional insureds with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts or equipment furnished in connection CITYCUP City of Cupertino Recreation and Community Services Department 10185 N. Stelling Road Cupertino, CA 95014 650-328-1000 38970 Abuse/Molestation PAGEHOLDER CODE NOTEPAD:INSURED'S NAME Date CITYCUP MISSI-3 2 Mission Academy of Music LLC OP ID: JS 03/11/2020 with such work or operations. This insurance is primary and non- contributory. Waiver of subrogation applies in favor of certificate holder. 30 day written cancellation notice will be given, 10 day notice for non-payment. CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECT PRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1001486 132849.8 01-23-2013 CATHERINE CHEN INSURANCE AGENCY INC. AGENT LICENSE NUMEBR: 0E83624 20132 STEVENS CREEK BLVD CUPERTINO CA 95014 CATHERINE CHEN 408-863-0000 408-863-1230 CATHERINE.CHEN.JXFY@STATEFARM.COM MISSION ACADEMY OF MUSIC LLC 25151 A Y Y 05/03/2020 05/03/2021 2,000,000 300,000 10,000 4,000,000 4,000,000 A Y Y 05/03/2020 05/03/2021 1,000,000 1,000,000 1,000,000 CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED, ENDORSEMENT CG 20 10 City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers, and Consultants CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014-3255 State Farm General Insurance Company 04/27/2020 CMP-4860.1 Page 1 of 2 CMP-4860.1 ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Policy No. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: Named Insured: MISSION ACADEMY OF MUSIC LLC Name And Address Of Additional Insured Person Or Organization: CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 3255 © , Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: c. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the con- tract or agreement to provide for such ad- ditional insured; and b. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or “suit” is tendered to us. You are required by contract or agreement to provide for such addi- tional insured. (2) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (1) “Your work” performed for that additional insured and included in the “products- completed operations hazard”. However, Paragraph 1. above is subject to the following: The insurance afforded to the additional insured only applies to the extent permit- ted by law; a. b.Products–Completed Operations In the performance of your ongoing operations; or (2) In connection with your premises; or(1) Premises And Ongoing Operationsa. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for “bodily injury”, “property damage”, or “personal and advertis- ing injury” caused, in whole or in part, by: 1. Your acts or omissions or the acts or omissions of those acting on your behalf: Available under the applicable Limits Of Insurance shown in the Declarations. b. Required by the contract or agreement; ora. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: 3. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a “suit” brought for damages for which you are provided coverage. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 2. The names and addresses of any in- jured persons and witnesses; and (2) How, when and where the “occur- rence” or offense took place; (1) See to it that we are notified as soon as practicable of an “occurrence” or an of- fense which may result in a claim. To the extent possible, notice should include: a. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: 4. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. Tender the defense and indemnity of any claim or “suit” to us and to all other insur- ers who may have insurance potentially available to the additional insured; and b. The nature and location of any injury or damage arising out of the "occur- rence” or offense; (3) Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. b. This insurance is primary to and will not seek contribution from any other insur- ance available to the additional insured, provided that the additional insured is a named insured under such other insur- ance. a. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II — LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: 5. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. c. CMP-4860.1 1007042 148020 08-26-2014 © , Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. All other policy provisions apply. There will be no refund of premium in the event this endorsement is cancelled. CMP-4860.1 Page 2 of 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be ________% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description 5 CITY OF CUPERTINO ITS CITY COUNCIL BOARDS AND COMMISSIONS OFFICERS OFFICIALS EMPLOYEES AGENTS SERVANTS VOLUNTEERS AND CONSULTANTS 10300 TORRE AVE CUPERTINO CA 95014-3202 CODE: 8868 CONTRACT: $8,000 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Insurance Company Countersigned By ______________________________________________ WC 04 03 06 (Ed. 4-84)1007722 124282.2 01-25-2019 State Farm Fire and Casualty Company 04/27/20 MISSION ACADEMY OF MUSIC LLC Manage your account: Go to www.farmers.com to access your account any time! Policy No. 56-6176 2nd Edition 3-19 11/13/2019 farmers.com Auto Insurance Declaration Page Page 1 of 3 Questions? Call your agent Alex Cheng at (510) 366-3317 or email acheng@farmersagent.com Premiums/Fees Policy Premium $1,520.00 Fees (*also see Information on Additional Fees below) $0.88 Policy Premium and Fees $1,520.88 This is not a bill. Policy Number: Effective:1/9/2020 12:01 AM Expiration:7/9/2020 12:01 AM Named Insured(s): Underwritten By:Farmers Insurance Exchange 6301 Owensmouth Ave. Woodland Hills,CA 91367 Household Drivers All persons who drive or will occasionally be driving any of the cars on the policy should be listed below. If anyone is missing or needs to be added, such as a newly licensed driver, you should contact your agent or the company to add that person before they begin to drive any of the cars covered on the policy. Name Driver Status Name Driver Status Covered Vehicle Information Veh. #Year/Make/Model/VIN LimitCoverageDeductible 1 Collision: $500 Additional Equipment:$1,000 Coverage Information Premiums by VehicleLimitsCoverage(applicable to all vehicles)Vehicle 1 Bodily Injury Liability $500,000 each person $1,000,000 each accident $273.20 Property Damage Liability $100,000 each accident $246.50 Permissive User Limit of Liability** Full (See Permissive User Limit of Liability in your policy) Included Medical Coverage $2,000 each person $33.80 Uninsured Motorist Bodily Injury $500,000 each person $500,000 each accident $121.40 farmers.com Page 2 of 3 Policy No. Questions? Call your agent Alex Cheng at (510) 366-3317 or email acheng@farmersagent.com Manage your account: Go to www.farmers.com to access your account any time! Declaration Page (continued) 56-6176 2nd Edition 3-19 Premiums by VehicleLimitsCoverage(applicable to all vehicles)Vehicle 1 Comprehensive $103.20 Collision $735.70 Additional Equipment Included Uninsured Motorist Property Damage With Collision $6.20 Towing and Road Service Not Covered Total Premium Per Vehicle $1,520.00 Policy Premium $1,520.00 Fee Detail Vehicle 1 Total Anti-Fraud Fee $0.88 $0.88 Fees $0.88 Policy Premium and Fees $1,520.88 Discounts Discount Type Applies to Vehicle(s)Discount Type Applies to Vehicle(s) Anti-Lock Brakes 1 Anti-Theft Dvce 1 Good Driver 1 Good Student 1 Auto/Home 1 Passive Restraint 1 Multiple Car 1 Driver Training 1 Group - Engineer 1 Stability Control 1 Auto/Umbrella 1 Safe Driver 1 Rating Information Details Vehicle 1 Garaging Zip 94303 Current Annual Mileage 13,000 Previous Annual Mileage 13,000 Vehicle Usage Other Use Years of Driving Experience 4-5 Policy and Endorsements This section lists the policy form number and any applicable endorsements that make up your insurance contract. Any endorsements that you have purchased to extend coverage on your policy are also listed in the coverages section of this declarations document: 56-5684 1st ed.; 25-8531 10-12; CA125 2nd ed. Mission Academy of Music Contract Final Audit Report 2020-05-14 Created:2020-05-13 By:Kevin Khuu (KevinK@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAj4lRZyBY1AGk1VGBEnhMAZNnCNNqk7Ju "Mission Academy of Music Contract" History Document created by Kevin Khuu (KevinK@cupertino.org) 2020-05-13 - 11:50:47 PM GMT- IP address: 73.158.53.147 Document emailed to Rachelle Sander (rachelles@cupertino.org) for signature 2020-05-13 - 11:53:24 PM GMT Email viewed by Rachelle Sander (rachelles@cupertino.org) 2020-05-14 - 6:40:36 PM GMT- IP address: 73.15.64.75 Document e-signed by Rachelle Sander (rachelles@cupertino.org) Signature Date: 2020-05-14 - 6:41:37 PM GMT - Time Source: server- IP address: 73.15.64.75 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2020-05-14 - 6:41:41 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2020-05-14 - 7:50:55 PM GMT- IP address: 104.47.44.254 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2020-05-14 - 7:51:05 PM GMT - Time Source: server- IP address: 148.64.105.190 Signed document emailed to Kirsten Squarcia (kirstens@cupertino.org), Rachelle Sander (rachelles@cupertino.org), Kevin Khuu (KevinK@cupertino.org), and cyrahc@cupertino.org 2020-05-14 - 7:51:05 PM GMT