22-092 CMO - Consulting Contract for City Manager Support Services - signed + [insurance]CITY OF
PROFESSIONAL/CONSULTING SERVICES AGREEMENT
CUPERTINO
1. PARTIES
This Agreement is made by and between the City of Cupertino, a municipal corporation ("City"),
and Greg Larson ("Contractor"), a sole proprietorship/individual for City Manager support
services, and is effective on the last date signed below ("Effective Date").
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. Contractor further agrees to carry
out its work in compliance with any applicable local, State, or Federal order regarding COVID-19.
3. TIME OF PERFORMANCE
3.1 This Agreement begins on the Effective Date and ends on September 30, 2022 ("Contract
Time"), unless terminated earlier as provided herein. Contractor's Services shall begin on the
effective date and shall be completed by October 30, 2022. The City's appropriate department head
or the City Manager may extend the Contract Time through a written amendment to this
Agreement, provided such extension does not include additional contract funds. Extensions
requiring additional contract funds are subject to the City's purchasing policy.
3.2 Schedule of Performance. Contractor must deliver the Services in accordance with the
Schedule of Performance, attached and incorporated here Exhibit A.
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
28,100.00 ("Contract Price"), based upon the scope of services in Exhibit A and the budget and
rates included in Exhibit B, Compensation attached and incorporated here. The maximum
compensation includes all expenses and reimbursements and will remain in place even if
Contractor's actual costs exceed the capped amount. No extra work or payment is 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
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claims for City approval. Failure to timely submit a complete and accurate payinent requisition
relieves City of any further payment or other obligations under the Agreement.
5. INDEPENDENT CONTRACTOR
51 Status. 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, worker's compensation, or other benefits from the City.
52 Contractor's Qualifications. Contractor warrants on behalf of 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 industry.
53 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, if required by the Cupertino Municipal Code.
54 Subcontractors. Only Contractor's employees are authorized to work under this
Agreement. Prior written approval from City is required for any subcontractor, and the terms and
conditions of this Agreement will apply to any approved subcontractor.
55 Tools, Materials, and Equipment. Contractor will supply all tools, materials and
equipment required to perform the Services under this Agreement.
56 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 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 remit 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.
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.
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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 upon completion of the
work to be performed hereunder or upon termination of this Agreement, to the extent requested by
City. In any case, no Work Product shall be shown to any third -party without prior written approval
of City.
7.2 Copyright. To the extent permitted by Title 17 of the U.S. Code, all Work Product arising
out of this Agreement is considered "works for hire" and all copyrights to the Work Product will
be the property of City. Alternatively, Contractor assigns to City all Work Product copyrights.
Contractor may use copies of the Work Product for promotion only with City's written approval.
73 Patents and Licenses. Contractor must pay royalties or license fees required for authorized
use of any third party 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 supporting documents must be kept separate from
other records and must be maintained for four (4) years from the date of City's final payment.
Contractor acknowledges that certain documents generated or received by Contractor in
connection with the performance of this Agreement, including but not limited to correspondence
between Contractor and any third party, are public records under the California Public Records
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Act, California Government Code section 6250 et seq. Contractor shall comply with all laws
regarding the retention of public records and shall make such records available to the City upon
request by the City, or in such manner as the City reasonably directs that such records be provided.
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
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;
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 property rights of any third party.
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 -party claim. 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
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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.
11.5. Contractor agrees to obtain executed indemnity agreements with provisions identical to
those set forth here in this Section 11 from each and every subcontractor, or any other person or
entity involved by, for, with, or on behalf of Contractor in the performance of this Agreement.
Failure of City to monitor compliance with these requirements imposes no additional obligations
on City and will in no way act as a waiver of any rights hereunder.
11.6. This Section 11 shall survive termination of the Agreement
12. INSURANCE
Contractor shall comply with the Insurance Requirements, attached and incorporated here as
Exhibit C, 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.
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.
13.2 Labor Laws. Contractor shall comply with all labor laws applicable to this. Agreement. If
the Scope of Services includes a "public works" component, Contractor is required to comply with
prevailing wage laws under Labor Code Section 1720 and other labor laws.
13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious
creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy,
age, sex, gender, sexual orientation, gender identity, Acquired -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 discrimination 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. Contractor agrees to provide records and documentation to the City on
request necessary to monitor compliance with this provision.
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13.4 Conflicts of Interest. Contractor shall comply with all conflict of interest laws applicable
to this Agreement and must avoid any conflict of interest. Contractor 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 Title 2 of the California Code of
Regulations. Contractor agrees to abide by the City's rules governing gifts to public officials and
employees.
13.5 Remedies. Any violation of Section 13 constitutes a material breach and may result in City
suspending payments, requiring reimbursements or terminating this Agreement. City reserves all
other rights and remedies available under the law and this Agreement, including the right to seek
indemnification under Section 11 of this Agreement.
14. PROJECT COORDINATION
City Project Manager. The City assigns Dianne Thompson 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 Greg Larson 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 must regularly update the City's Project Manager about the progress
with the work or any delays, as required under the Scope of Services. City written approval is
required prior to substituting a new Representative.
15. ABANDONMENT OF PROJECT
City may abandon or postpone the Project or parts therefor at any time. Contractor will be
compensated for satisfactory Services performed through the date of abandonment, and will be
given reasonable time to assemble the work and close out the Services. With City's pre -approval
in writing, the time spent in closing out the Services will be compensated up to a maximum of ten
percent (10%) of the total time expended to date in the 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 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
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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.
18. ATTORNEY FEES
If City initiates legal action, files a complaint or cross -complaint, or pursues arbitration, appeal, or
other proceedings to enforce its rights or a judgment in connection with this Agreement, the
prevailing party will be entitled to reasonable attorney fees and costs.
19. THIRD PARTY BENEFICIARIES
There are no intended third party 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 of a breach shall not constitute waiver of another provision or breach.
21. ENTIRE AGREEMENT
This Agreement represents the full and complete understanding of every kind or nature between
the Parties, and supersedes any other agreement(s) and understanding(s), either oral or written,
between the Parties. Any modification of 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 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.
22. INSERTED PROVISIONS
Each provision and clause required by law for this Agreement is deemed to be included and will
be inferred herein. Either party may request an amendment to cure mistaken insertions 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 part of the Agreement and in
no way affect, limit, or amplify the terms or provisions of this Agreement.
24. SEVERABILITY/PARTIAL INVALIDITY
If any term or provision of this Agreement, or their application to a particular situation, is found
by the court to be void, invalid, illegal, or unenforceable, such term or provision shall remain in
force and effect to the extent allowed by such ruling. All other terms and provisions of this
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Agreement or their application to specific situations shall remain in full force and effect. The
Parties 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, Records, Governing Law,
and Attorney Fees, shall survive the Agreement and remain in full force and effect.
26. NOTICE
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 Cupertino
Office of the City Manager
10300 Torre Ave.,
Cupertino, CA 95014
Attention: Dianne Thompson
Email: DianneT@cupertino.org
27. EXECUTION
To Contractor:
Greg Larson
Attention: Greg Larson
Email: greg@larsonbeaudry.com
The person executing this Agreement on behalf of Contractor represents and warrants that
Contractor has full right, 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 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.
CITY OF CUPERTINO
A Municipal Corporation
By
Name
Dianne Thompson (she/her)
Title Acting City Manager
Date Jul 15, 2022
City Manager Support Services
CONTRACTOR
R-Z
Name Greg Larson
Title Consultant
Date Jul 15, 2022
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APPROVED AS TO FORM:
6l vli trhel- 0 Je/rfee
CHRISTOPHER D. JENSEN
Cupertino City Attorney
ATTEST:
KIRSTEN SQUARCIA
City Clerk
DateJu115) 2022
City Manager Support Services
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Exhibit A — Scope of Services
Consultant shall provide consulting services to the City's next City Manager as set forth
in Task 1.
Approach
Consultant's engagement with the next City Manager would solely be under their request
and direction. Unless mutually agreed to otherwise, all discussions between Consultant
and the next City Manager are confidential given the inherent personnel -related matters
to be discussed.
Task 1— Consulting Services
Consultant shall be available, as requested by the next City Manager, for up to ten hours
per week through September 2022, up to a total of 35 hours, except for the last Thursday
of any month.
Optional Additional Consulting Services
At the sole discretion of the next City Manager, Consultant shall provide up to an
additional 95 hours of consulting services to the next City Manager, subject to the date
limitation set forth under Task 1.
Optional Task 2 — City Council Governance Workshop
If requested by the next City Manager and agreed to by the City Council, Consultant will
facilitate a half- day Council workshop. The preparatory work for this workshop will
include confidential interviews with the Mayor and City Council, the City Manager and
City Attorney, and others as needed or requested. Consultant will then prepare and
interview summary identifying major themes and issues to be discussed at the workshop,
as well as a draft discussion outline and PowerPoint presentation to be used for the
workshop. The workshop itself would be facilitated in an engaging fashion using an array
of small and large group discussion tools, including "cheap consensus," dotting, shared
discourse, and collective sequential decision -making.
Exhibit B - Compensation
Fee
Consulting services will be charged at a discounted rate of $140 per hour, inclusive of
travel time and all direct expenses (e.g., mileage).
Optional Task 2 - City Council Governance Workshop, if requested, will cost a fixed fee
of $9,900. The Task 2 fixed fee includes all direct expenses, including travel.
The total not to exceed amount of the engagement is as follows:
Task 1- up to 35 hours of consultation @ $140 per hour $ 4,900
Optional additional consultation hours as requested (up to 95 hours) $13,300
Optional Task 2 - City Council Governance Workshop 9,90
TOTAL ENGAGEMENT NOT TO EXCEED AMOUNT $28,100
EXHIBIT C
Insurance Requirements
Consultant shall procure prior to commencement of Services and maintain for the duration of the contract,
at its own cost and expense, the following insurance policies and coverage with companies doing business in
California and acceptable to City.
INSURANCE POLICIES AND MINIMUMS REQUIRED
1. OMITTED
2. Automobile Liability: ISO CA 00 01 covering any auto (including owned, hired, and non -owned
autos) with limits no less than $1,000,000 per accident for bodily injury and property damage.
3. Workers' Compensation: As required by the State of California, with Statutory Limits and
Employer's Liability Insurance of no less than $1,000,000 per occurrence for bodily injury ordisease.
J Not required. Consultant has provided written verification of no employees.
4. Professional Liability for professional acts, errors and omissions, as appropriate to Consultant's
profession, with limits no less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. If written
on a.claims made form:
a The Retroactive Date must be shown and must be before the Effective Date of the Contract.
b. Insurance must be maintained for at least one (1) year after completion of the Services.
a 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 Consultant must purchase
extended reporting" coverage for a minimum of one (1) year after completion of the Services.
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
Exh. C-Insurance Requirements Form Updated Jan. 2022
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 ofInsurers
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.
Exh. C-Insurance Requirements Form Updated Jan. 2022
ACOR '
0
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
08/11/2022
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).
PRODUCER
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA
5 Concourse Parkway
Suite 2150
CONTACINAME
WINE.,(AIExt (888) 202-3007 FAXC NoAC'
E-MAILADDRESS contact@hiscox.com
INSURER(S) AFFORDING COVERAGE NAIC # Atlanta GA, 30328
INSURER A Hiscox Insurance Company Inc 10200
INSURED
Greg Larson
INSURER B
INSURER C
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. 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.
INSRLTR TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MWDD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence S
MED EXP (Any one person) S
PERSONAL & ADV INJURY S
GEN'L AGGREGATE L MIT APPL ES PER GENERAL AGGREGATE S
POLICY D PRO JECT LOC PRODUCTS - COMP/OP AGG S
OTHER:
AUTOMOBILE LIABILI Y COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person) 5ANYAUTO
OWNED F SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident)
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTYDAMAGE
Per accident S
S
UMBRELLALIAB OCCUR EACH OCCURRENCE S
AGGREGATE S
EXCESS UAB CLAIMS -MADE
DED I I RETENTION $ S
WORKERS COMPENSATION PERTOTH- AND
EMPLOYERS'LIABILITY Y ! N STAUTE
ER E.L.
EACH ACC DENT S ANYPROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED?
NIA E.L.
DISEASE - EA EMPLOYEE S Mandatory inNH) If yes,
describe under DESCR PTION
OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S A Professional
Liability Y UDCA982941-EO-21 10/11/2021 10/11/2022 Each Claim: 2,000,000 Aggregate: 2,
000,000 DESCRIPTION OF
OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) I.CR
I itIVH r C MULUCR I.AIVI.CLLH I IVIV City of
Cupertino 10300 Torre
Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cupertino, CA
95014 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE
I I`
y''
r'Ir' 1r @
1988-
2015 ACORD CORPORATION. All rights reserved. ACORD 25 (
2016/03) The ACORD name and logo are registered marks of ACORD
RLI Insurance Company
RL[-` Peoria, Illinois 61615
A stock insurance company, herein called the Company
PERSONAL UMBRELLA LIABILITY POLICY
This Declarations page with "Policy Provisions" completes this policy.
DECLARATIONS
Policy Number PUP2043828 4/21/2022
Named Insured & Mailing Address Agent
GREG LARSON D6569 GEICO Insurance Agency, LLC
855)820-5807
PO Box 5578
Fredericksburg, VA 22412
Primary Residence Address (if different than above) Insured's Brokering Agent
Same As Above E8475 GEICO
Policy Period — 12:01 A.M. standard time at the address
of the Named Insured as stated herein. From 04/22/2022 To 04/22/2023
Limit of Coverage $ 1,000,000 each occurrence
Excess Uninsured/Underinsured Motorists
Limit of Coverage $ 0 each accident Coverage Rejected
Policy Premium $266
Self -Insured Retention: $500 each occurrence
Forms included at issue will appear on Page 2 of this Declaration.
REQUIRED BASIC POLICIES
It is agreed by you that you and any Relative will be covered by an Automobile liability policy for any Automobile you operate or
your Relative operates for at least the minimum limits listed below. It is also agreed by you that you and any Relative will be
covered by a personal liability policy for at least the minimum limits listed below. If you or your Relatives are not covered under
your policies for at least the minimum limits listed below, they must be covered under another Automobile liability policy and
another personal liability policy for at least the minimum limits below. If you or your Relatives own a Farm, Seasonal/Secondary/
Rental Properties, Recreational Vehicles or Watercraft, you or your Relatives, as the case may be, agree to carry the appropriate
policy (or endorsements) listed below covering both you and your Relatives for at least the minimum limits listed below.
Basic Policy Minimum Limit of Coverage
A. Automobile Liability Bodily Injury $ 250,000 each person
500,000 each occurrence
Property Damage $ 50,000 each occurrence
or
Bodily Injury $ 300,000 each person
300,000 each occurrence
Property Damage $ 50,000 each occurrence
or
Bodily Injury and Property Damage
Combined Single Limit $ 300,000 each occurrence
continued on page 2)
PUP 301 (04/10) Page 1 of 2
Contractor/Consultant Affidavit of No Employees
State of California
County of Santa C7ara
City of Cupertino
I, the indersigned, declare as follows:
I am an independent contractor and the owner of Greg larSOn' consultant
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 u"ider the laws of the State of Califomia that the foregoing is true
and correct.
Executed on this
15
day of July , 2022, at Santa Cruz , California.
Greg larson
PRINT NAME
SIGNATURE
Revised 2.03.22