B - Proof of Insurance — Cupertino City Council, November 15, 2022

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

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
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 (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR

LTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF
(MM/DD/YYYY)

POLICY EXP
(MM/DD/YYYY) LIMITS
PER

STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$

ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under
DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?

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.

INSD
ADDL
WVD
SUBR
N / A
$
$
(Ea accident)
(Per accident)
OTHER:

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).

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.
3/29/2022
Marsh & McLennan Agency, LLC
2000 Brookstone Centre Pkwy
Suite 118
Columbus GA 31904
Connie Whitmer
706-324-6671
706-576-5607
[email protected]
Federal Insurance Company A++ XV
20281
30GLOBALPAYM
Great Northern Insurance Company A++ XV
20303
Active Network LLC
Attention: Devery Gauthier
3550 Lenox Road NE, Suite 3000
Atlanta GA 30326
ACE American Insurance Company A++ XV
22667
204066101
A
X
1,000,000
X
1,000,000
10,000
1,000,000
2,000,000
X
X
36048071
4/1/2022
4/1/2023
1,000,000
Gen Agg Cap
100,000,000
B
1,000,000
X
X
Hired Comp
X
Hired Coll
73614277
4/1/2022
4/1/2023
Hired Phy Dmg - ACV
1,000 Deds
A
X
25,000,000
79894591
25,000,000
4/1/2022
4/1/2023
C
A
71750292
71750293
4/1/2022
4/1/2022
4/1/2023
4/1/2023
X
1,000,000
1,000,000
1,000,000
City, its City Council, boards and commissions, officers, employees and volunteers as its interest may appear (GL) Additional Insured per form: 80-02-2367 Additional Insured Scheduled Person or Organization City of Cupertino
City Clerk
10300 Torre Ave
Cupertino CA 95014-3202

$1MHolder Identifier : 7777777707070700077763616065553330762716446205457707453136762406210073750576057331030762514002076011307522415332274112075662735364763300772601557205675207344015750276112077727252025773110777777707000707007 6666666606060600062606466204446200602000426226022006022024042262220060200042622602200622200406004020206220206262062200062202062400420000620202624006000006000226242002622066646062240664440666666606000606006Certificate No : 570090553711

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)
12/07/2021
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).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

PRODUCER
Aon Risk Services South, Inc.

Atlanta GA Office
3550 Lenox Road NE
Suite 1700
Atlanta GA 30326 USA
PHONE
(A/C. No. Ext):

E-MAIL
ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 22322Greenwich Insurance CompanyINSURER A:

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

FAX
(A/C. No.): (800) 363-0105

CONTACT
N
AME:

Active Network LLC
717 N Harwood Street
Suite 2700
Dallas TX 75201 USA
COVERAGES CERTIFICATE NUMBER: 570090553711 REVISION NUMBER:

POLICY EXP
(MM/DD/YYYY)

POLICY EFF
(MM/DD/YYYY)
SUBR
WVD
INSR
LTR
ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG
GEN'L AGGREGATE LIMIT APPLIES PER:

PRO-
JECT
OTHER:

AUTOMOBILE LIABILITY

ANY AUTO
OWNED

AUTOS ONLY

SCHEDULED
AUTOS

HIRED AUTOS
ONLY

NON-OWNED

AUTOS ONLY
BODILY INJURY ( Per person)

PROPERTY DAMAGE
(Per accident)
BODILY INJURY (Per accident)

COMBINED SINGLE LIMIT
(Ea accident)

EXCESS LIAB
OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE
DED

UMBRELLA LIAB

RETENTION
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT
OTH-
ER

PER STATUTE
Y / N
(Mandatory in NH)

ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / A

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY
If yes, describe under
DESCRIPTION OF OPERATIONS below
LimitMTP904216901 12/01/2021 12/01/2022
Claims Made-include Cyber $20,000,000Retention
E&O-MPL-PrimaryA
SIR applies per policy terms & conditions
$10,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVE
City of Cupertino
10300 Torre Avenue
Cupertino CA 95014-3202 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE

EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

ATTACHMENT B
Participating Insurers:

AGENCY CUSTOMER ID:

ADDITIONAL REMARKS SCHEDULE
LOC #:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER : ACORD 25 FORM TITLE : Certificate of Liability Insurance EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED AGENCY
See Certificate Number :

See Certificate Number :

Aon Risk Services South, Inc.
570000075610
570090553711
570090553711
Page _ of _
Active Network LLC
Professional Services Liability and Technology Services / Privacy & Cyber Security Liability Program December 1, 2021 to December 1, 2022 Policy Term:

Primary $10M Layer :

Greenwich Insurance Company -
Policy No. MTP904216901 / NAIC # 22322
SIR applies per policy terms & conditions.
$12.5M excess of $10M Layer :

The ACORD name and logo are registered marks of ACORD
Schedule of Named Insured Entities:

AGENCY CUSTOMER ID:

ADDITIONAL REMARKS SCHEDULE
LOC #:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER : ACORD 25 FORM TITLE : Certificate of Liability Insurance EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED AGENCY
See Certificate Number :

See Certificate Number :

Schedule of Named Insured Entities:

OpenEdge Payments LLC
GP Finance, LLC
Global Payment Holding Company
Global Payment Systems LLC
Global Payments Acquisition Corporation 3, LLC
Global Payments Inc.

Global Payments Direct, Inc.

Greater Giving, Inc.

PayPros LLC
Storman Software, Inc.

Heartland Payment Systems, LLC
Heartland Acquisition, LLC
Debitek, Inc.

Educational Computer Systems, Inc.

Xenial, Inc.

Xpient, LLC
Heartland Payroll Solutions, Inc.

Payroll 1, Inc.

TouchNet Information Systems, Inc.

Active Network Ipico Holdings (US), LLC
Active Network IPICO (Us) Inc.

Active Network, LLC
Jumpforward LLC
Maximum Solutions, LLC

HK US LLC
VEPF IV AIV VII-C Corp.

Georgetown Merger Sub, Inc.

AdvancedMD, Inc.

Nuesoft Technologies Inc.

AllStar Billing Services, LLC
SICOM Systems, Inc.

Nextep Systems Inc.

Mobile Bytes LLC
3PointData, Inc.

Global Payments Americas Holding LLC
Total System Services LLC
Cayan Holdings LLC
Cayan LLC
Central Payment Co., LLC
Central Payment Deployment, Inc.

Columbus Depot Equipment Company (LLC)
Columbus Productions, Inc.

ProPay, Inc.

TransFirst Parent Corp.

TransFirst Group Inc.

TSYS Acquiring Solutions, LLC
TSYS Advisors, Inc.

TSYS Merchant Solutions, LLC
NetSpend Corporation
NetSpend Holdings, Inc.

Skylight Acquisition I, Inc.

Paylease Holdings, LLC
Paylease LLC
Zego, Inc.

MineralTree, Inc.

Global Payments Check Recovery Services, Inc.

Global Payments Check Services, LLC
Global Payments Gaming International, Inc.

Global Payments Gaming Services, Inc.

The ACORD name and logo are registered marks of ACORD

Cupertino City CouncilNovember 15, 2022

Cupertino City Council
November 15, 2022