1 FIRST AMENDMENT TO AGREEMENT 539 BETWEEN
THE CITY OF CUPERTINO AND HINDERLITER, DE
LLAMAS AND ASSOCIATES ( HdL) FOR SALES, USE
AND TRANSACTIONS TAX AUDIT SERVICES
This First Amendment to Agreement 539 betweenthe City of Cupertino and Hinderliter, de Llamas and Associates (HdL) is by and betweenthe City of Cupertino, a municipal corporation hereinafter " City") and Hinderliter, de Llamas and Associates, LLC., a California Corporation Contractor”) whose addressis 120 S. StateCollege Blvd., Suite 200, Brea, CA 92821, and is made with reference to the following:
RECITALS:
A. On July 08, 2020 Agreement 539 (“ Agreement”) was entered into by and between City and Contractor for Hinderliter, de Llamas and Associatesa California Corporation for Sales, Use and Transactions Tax audit services.
B. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein.
NOW, THEREFORE, it is mutually agreed by and between and undersigned parties as follows:
1. TIME OF PERFORMANCE
Paragraph3.1 of the Agreement is modified to readasfollows:
This Agreement begins on the Effective Date and ends on June 30, 2023 (“ Contract Time”), unlessterminated earlier asprovided herein. The City’s appropriate departmentheador City Manager may extend the Contract Time through a written amendment to this Agreement, provided such extension doesnot include additional contract funds. Extensions requiring additional contract funds are subject to the City’ s purchasing policy.
2. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the sameand shall be in full force andeffect.
SIGNATURES CONTINUE ON THE FOLLOWING PAGE
2 IN WITNESS WHEREOF, the parties hereto have causedthis modification of Agreement to be executed.
CITY OF CUPERTINO
By
Title
Date
APPROVED AS TO FORM
City Attorney
ATTEST:
City Clerk
Date
HINDERLITER DE LLAMAS AND
ASSOCIATES
By
Title
Date
Andrew Nickerson
President/ CEO
06/ 28/ 22
Director of Administrative Services
06/ 28/ 22
Christopher D. Jensen
06/ 28/ 22
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER( S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
A/ C, No):
FAX
E-
MAILADDRESS:
PRODUCER
A/ C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
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
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.
OTHER:
Per accident)
Ea accident)
N / A
SUBR
WVD
ADDL
INSD
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.
PROPERTY DAMAGE
BODILY INJURY ( Per accident)
BODILY INJURY ( Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOSONLY
NON- OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/ MEMBER EXCLUDED?
Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/ PARTNER/ EXECUTIVE
E. L. DISEASE - POLICY LIMIT
E. L. DISEASE - EA EMPLOYEE
E. L. EACH ACCIDENT
EROTH-STATUTEPER
LIMITS(MM/ DD/ YYYY)
POLICY EXP(
MM/ DD/ YYYY)
POLICY
EFFPOLICYNUMBERTYPEOFINSURANCELTRINSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ( ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $ EACH OCCURRENCE
AGGREGATE
OCCUR
CLAIMS- MADE
DED RETENTION $
PRODUCTS - COMP/ OP AGG
GENERAL AGGREGATE
PERSONAL & ADV INJURY
MED EXP ( Any one person)
EACH OCCURRENCE
DAMAGE TO RENTED $
PREMISES ( Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS- MADE OCCUR
GEN' L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE ( MM/ DD/ YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 ( 2016/ 03)
1988- 2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
5/19/ 2022
Woodruff Sawyer
2 Park Plaza, Suite 500
Irvine CA 92614
Audrey Curtis
949- 435- 7345
acurtis@woodruffsawyer. com
National Fire Insurance Company of Hartford 20478
HDLCOMP- 01 Continental Insurance Company
35289HinderliterdeLlamas&Associates
HdL Software, LLC.
120 S. State College Blvd, Suite 200
Brea CA 92821
Valley Forge Insurance Company 20508
Nautilus Insurance Company 17370
Continental Casualty Company 20443
Federal Insurance Company 20281
544786930
C X 1,000, 000
X 1,000, 000
15, 000
1,000, 000
2,000, 000
X
Y Y 6056953483 5/26/ 2022 5/26/ 2023
2,000, 000
A 1,000, 000
X
Y Y 6056953466 5/26/ 2022 5/26/ 2023
B X X 5,000,00060569535025/ 26/ 2022 5/26/ 2023
5,000, 000
X 10, 000
D
E
F
Professional Liability/ Claim Made
Cyber Liability
Crime
MEO90571750522
6078657761
82556901
5/26/ 2022
5/26/ 2022
5/26/ 2022
5/26/ 2023
5/26/ 2023
5/26/ 2023
Each Claim/ Aggregate
Cyber Limit
Crime Limit
2,000, 000
2,000, 000
1,000, 000
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are included as Additional Insured on a Primary and Non- contributory basis with a Waiver of Subrogation to the extent provided in the attached forms. Notice of Cancellation applies to the extent provided in the attached form.
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
10300 Torre Avenue
Cupertino CA 95014
Business Auto Policy
Policy
5. a.
1)
2)
b.
c.
d.
6. a.
b.
7. a.
b.
1)
2)
3)
4)
5)
Other Insurance
For any covered " auto" you own, this Coverage Form provides primary insurance. For any covered auto" you don' t own, the insurance provided by this Coverage Form is excess over any other collectible insurance. However, while a covered " auto" which is a " trailer" is connected to another vehicle, the Covered Autos Liability Coverage this Coverage Form provides for the " trailer" is:
Excess while it is connected to a motor vehicle you do not own; or Primary while it is connected to a covered " auto" you own.
For Hired Auto Physical Damage Coverage, any covered " auto" you lease, hire, rent or borrow is deemed to be a covered " auto" you own. However, any " auto" that is leased, hired, rented or borrowed with a driver is not a covered " auto".
Regardless of the provisions of Paragraph a. above, this Coverage Form' s Covered Autos Liability Coverage is primary for any liability assumed under an " insured contract".
When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis.
Premium Audit
The estimated premium for this Coverage Form is based on the exposures you told us you would have when this policy began. We will compute the final premium due when we determine your actual exposures. The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the balance, if any. The due date for the final premium or retrospective premium is the date shown as the due date on the bill. If the estimated total premium exceeds the final premium due, the first Named Insured will get a refund.
If this policy is issued for more than one year, the premium for this Coverage Form will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy.
Policy Period, Coverage Territory
Under this Coverage Form, we cover " accidents" and " losses" occurring:
During the policy period shown in the Declarations; and Within the coverage territory.
The coverage territory is:
The United States of America;
The territories and possessions of the United States of America; Puerto Rico;
Canada; and
Anywhere in the world if a covered " auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 30 days or less, provided that the " insured' s" responsibility to pay damages is determined in a " suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada, or in a settlement we agree to.
We also cover " loss" to, or " accidents" involving, a covered " auto" while being transported between any of these places.
Underwriting Company:
Policy ; Page: 12 of 16
Policy Page: 30 of75NationalFire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606
Policy No:
Policy Effective Date:
Form No: CA 00 01 10 13
Copyright Insurance Services Office, Inc., 2012
6056953466
05/ 26/ 2022
Technology General Liability Extension Endorsement
K. Other Person Or Organization / Your Work
Any person or organization who is not an additional insured under Paragraphs A. through J. above. Such additional insured is an Insured solely for bodily injury, property damage or personal and advertising injury for which such additional insured is liable because of the Named Insured’ s acts or omissions.
The coverage granted by this paragraph does not apply to any person or organization:
1. who is specifically scheduled as an additional insured on another endorsement to this Coverage Part; nor
2. for bodily injury or property damage included within the products- completed operations hazard except to the extent all of the following apply:
a. this Coverage Part provides such coverage;
b. the written contract or agreement described in the opening paragraph of this ADDITIONAL INSUREDS Provision requires the Named Insured to provide the additional insured such coverage; and
c. the bodily injury or property damage results from your work that is the subject of the written contract or agreement, and such work has not been excluded by endorsement to this Coverage Part.
2. ADDITIONAL INSURED - PRIMARY AND NON- CONTRIBUTORY TO ADDITIONAL INSURED’ S INSURANCE A. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph:
If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured' s own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured' s own insurance means insurance on which the additional insured is a named insured.
B. With respect to persons or organizations that qualify as additional insureds pursuant to paragraph 1. K. of this endorsement, the following sentence is added to the paragraph above:
Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization.
3. BODILY INJURY – EXPANDED DEFINITION
Under DEFINITIONS, the definition of bodily injury is deleted and replaced by the following:
Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury, sickness or disease.
4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE
Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit Condition is amended to add the following provisions:
A. BROAD KNOWLEDGE OF OCCURRENCE
The Named Insured must give the Insurer or the Insurer’ s authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner, executive officer, manager or member of a Named Insured, or to an employee designated by any of the above to give such notice.
B. NOTICE OF OCCURRENCE
CNA74872XX ( 1- 15)
Policy No:
Endorsement No:
Effective:
Insured Name:
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 6056953483
05/ 26/ 2022
POLICY NUMBER: COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 04 44 10 13 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US ( WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured:
Endorsement Effective Date:
SCHEDULE
Name( s) Of Person( s) Or Organization( s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against
Others To Us condition does not apply to the
person( s) or organization( s) shown in the Schedule,
but only to the extent that subrogation is waived prior to the " accident" or the " loss" under a contract with that person or organization.
6056953466
Hinderliter de Llamas & Associates
5/ 19/ 2022
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 10300 Torre Avenue
Cupertino, CA 95014
1$ 3DUDPRXQW
Waiver of Transfer of Rights of Recovery Against
Others to the Insurer Endorsement
Policy No:
Endorsement No:
Effective Date:
Endo EffectiveDate
CNA75008XX ( 10- 16)
Page of
1$}
Insured Name: + LQGHUOLWHUGH ODPDV VVRFLDWHV G/ 6RIWZDUH Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following:
With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured’ s ongoing operations or your work included in the products- completed operations hazard.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy.
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 95014Cupertino10300TorreAvenueCA
6056953483
05/ 26/ 2022
5/ 19/ 2022
POLICY NUMBER: 6056953466 COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 20 48 10 13 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person( s) or organization( s) who are " insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured:
Endorsement Effective Date:
SCHEDULE
Name Of Person( s) Or Organization( s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is
an " insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an " insured" under the Who Is An Insured
provision contained in Paragraph A. 1. of Section II –
Covered Autos Liability Coverage in the Business
Auto and Motor Carrier Coverage Forms and
Paragraph D.2. of Section I – Covered Autos
Coverages of the Auto Dealers Coverage Form.
Hinderliter de Llamas & Associates
5/ 19/ 2022
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 10300 Torre Avenue
Cupertino, CA 95014
1$ 3DUDPRXQW
Additional Insured - Designated Person
or Organization Endorsement
Policy No:
Endorsement No:
Effective Date:
CNA74745XX ( 1-15)
Page RI
PolUWCompany 1$ 3DUDPRXQW
Insured Name: + G/ RPSDQLHV
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person Or Organization:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
It is understood and agreed that the section entitled WHO IS AN INSURED is amended with the addition of the following:
A. The person or organization shown in the Schedule is an Insured, but only with respect to such person or organization’ s liability for bodily injury, property damage or personal and advertising injury caused in whole or in part, by: the Named Insured’ s acts or omissions, or the acts or omissions of those acting on the Named Insured’ s behalf:
1. in the performance of the Named Insured’ s ongoing operations; or
2. in connection with premises owned by or rented to the Named Insured.
B. However, if coverage for the additional insured is required by written contract or written agreement, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with:
1. coverage broader than required by such contract or agreement; or
2. a higher limit of insurance than required by such contract or agreement.
C. The coverage granted by this endorsement does not apply to bodily injury or property damage included within the products- completed operations hazard.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy.
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers Cupertino10300TorreAvenue CA 95014
6056953483
5/ 19/ 2022
CERTIFICATE OF LIABILITY INSURANCE
DATE ( MM/ DD/ YYYY)
05/ 31/ 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 endors ement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement( s).
PRODUCER
Aon Risk Services, Inc of Florida
1001 Brickell Bay Drive, Suite # 1100
Miami, FL 33131- 4937
CONTACT
NAME: Aon Risk Services, Inc of Florida
PHONE
A/ C, No, Ext): 800- 743- 8130
FAX
A/ C, No): 800- 522- 7514
EMAIL
ADDRESS: ADP. COI. Center@Aon. com
INSURER( S) AFFORDING COVERAGE NAIC #
INSURER A : AIU Insurance Company 19399
INSURED
ADP TotalSource DE IV, Inc.
5800 Windward Parkway
Alpharetta, GA 30005
L/ C/ F
Hinderliter de Llamas & Associates
120 S State College Blvd, Suite 200
Brea, CA 928210000
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 3897215 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. LIMITS SHOWN ARE AS REQUESTED.
INSR
LTR TYPE OF INSURANCE ADDL
INSR
SUBR
WVD POLICY NUMBER POLICY EFF
MM/ DD/ YYYY)
POLICY EXP
MM/ DD/ YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS- MADE OCCUR
DAMAGE TO RENTED
PREMISES ( Ea occurrence) $
MED EXP ( Any one person) $
PERSONAL & ADV INJURY $
GEN' L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS - COMP/ OP AGG $
OTHER $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident) $
ANY AUTO BODILY INJURY ( Per person) $
OWNED
AUTOS ONLY
SCHEDULED
AUTOS BODILY INJURY ( Per accident) $
HIRED
AUTOS ONLY
NON- OWNED
AUTOS ONLY
PROPERTY DAMAGE
Per accident) $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS- MADE AGGREGATE $
DEC RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/ PARTNER/ EXECUTIVE
OFFICER/ MEMBER EXCLUDED?
Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N / A WC 011092784 CA 03/ 25/ 2022 07/ 01/ 2022
X PER
STATUTE
OTH-
ER
E. L. EACH ACCIDENT $ 2,000, 000
E. L. DISEASE - EA EMPLOYEE $ 2,000, 000
E. L. DISEASE - POLICY LIMIT $ 2,000, 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ( ACORD 101, Additional Remarks Schedule, may be attached if more space is re quired) All worksite employees working for HINDERLITER DE LLAMAS & ASSOCIATES, paid under ADP TOTALSOURCE, INC’s payroll, are covered under the above stated policy.
CERTIFICATE HOLDER CANCELLATION
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
10300 Torre Avenue
Cupertino, CA 95014
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1988- 2015 ACORD CORPORATION. All rights reserved.
ACORD 25 ( 2016/ 03) The ACORD name and logo are registered marks of ACORD Exh. D-InsuranceRequirementsfor DesignProfessionals & ConsultantContracts 1 Form UpdatedJan. 2022
Consultantshallprocurepriortocommencementof Servicesandmaintainfor thedurationof thecontract, atits owncostandexpense, thefollowinginsurancepoliciesandcoveragewithcompaniesdoingbusinessin CaliforniaandacceptabletoCity.
INSURANCEPOLICIES AND MINIMUMS REQUIRED
1. CommercialGeneralLiability (CGL) forbodilyinjury, propertydamage, personalinjuryliability for premisesoperations, productsand completedoperations, contractualliability, and personaland advertisinginjury with limits no lessthan $2,000,000peroccurrence (ISO FormCG 00 01). If a generalaggregatelimit applies, eitherthe generalaggregatelimit shall apply separatelyto this project/location (ISOFormCG2503or 2504) or it shallbetwicetherequiredoccurrencelimit. a. It shallbea requirementthatanyavailableinsuranceproceedsbroaderthanor in excessof the specifiedminimuminsurancecoveragerequirementsand/or limits shallbe madeavailableto the AdditionalInsuredandshallbe (i) theminimumcoverage/limitsspecifiedin thisagreement; or (ii) the broadercoverageandmaximumlimitsof coverageof anyinsurancepolicy, whicheverisgreater. b. AdditionalInsuredcoverageunderConsultant's policyshallbe "primaryandnon-contributory," will notseekcontributionfrom City’s insurance/self-insurance, andshallbeatleastasbroadasISO FormCG2010 (04/13).
c. Thelimits of insurancerequiredmaybesatisfiedby a combinationof primaryandumbrellaor excessinsurance, providedeachpolicycomplieswith therequirementssetforthin thisContract. Any umbrellaor excessinsuranceshallcontainor beendorsedto containa provisionthatsuchcoverage shallalsoapplyon a primarybasisfor thebenefitof City beforetheCity’s owninsuranceor self- insuranceshallbecalleduponto protectCity asanamedinsured.
2. AutomobileLiability: ISOCA 0001coveringanyauto (includingowned, hired, andnon-owned autos) with limits nolessthan $1,000,000peraccidentfor bodily injury andpropertydamage.
3. Workers’ Compensation: As requiredby the Stateof California, with StatutoryLimits and Employer’sLiability Insuranceof nolessthan $1,000,000peroccurrenceforbodilyinjuryordisease.
Notrequired. Consultanthasprovidedwrittenverificationof noemployees.
4. ProfessionalLiability for professionalacts, errorsand omissions, as appropriateto Consultant’s profession, withlimitsnolessthan $2,000,000peroccurrenceorclaim, $2,000,000aggregate. If written onaclaimsmadeform:
a. TheRetroactiveDatemustbeshownandmustbebeforetheEffectiveDateof theContract. b. Insurancemustbemaintainedfor atleastfive (5) yearsaftercompletionof theServices. c. If coverageiscanceledornon-renewed, andnotreplacedwithanotherclaims-madepolicyform with aRetroactiveDatepriorto theContractEffectiveDate, theConsultantmustpurchase extendedreporting” coveragefor aminimumof five (5) yearsaftercompletionof theServices.
EXHIBIT D
InsuranceRequirements
DesignProfessionals & ConsultantsContracts
Exh. D-InsuranceRequirementsfor DesignProfessionals & ConsultantContracts 2 Form UpdatedJan. 2022
OTHER INSURANCEPROVISIONS
Theaforementionedinsuranceshallbeendorsedandhaveall thefollowingconditionsandprovisions:
AdditionalInsuredStatus
TheCity of Cupertino, its City Council, officers, officials, employees, agents, servantsandvolunteers AdditionalInsureds”) areto becoveredasadditionalinsuredsonConsultant’sCGLandautomobile liability policies. GeneralLiability coveragecanbeprovidedin theformof anendorsementto Consultant’s insurance (atleastasbroadasISOFormCG2010 (11/ 85) or bothCG2010andCG2037forms, if later editionsareused).
PrimaryCoverage
Coverageaffordedto City/AdditionalInsuredsshallbeprimaryinsurance. Any insuranceor self-insurance maintainedby City, its officers, officials, employees, or volunteersshallbeexcessof Consultant’s insurance andshallnotcontributeto it.
Noticeof Cancellation
Eachinsurancepolicyshallstatethatcoverageshallnotbecanceledorallowedto expire, exceptwith written noticeto City 30daysin advanceor 10daysin advanceif dueto non-paymentof premiums.
Waiverof Subrogation
Consultantwaivesanyright to subrogationagainstCity/AdditionalInsuredsfor recoveryof damagesto the extent said lossesare coveredby the insurancepolicies requiredherein. Specifically, the Workers’ Compensationpolicyshallbeendorsedwith awaiverof subrogationin favorof City for all workperformed by Consultant, its employees, agentsandsubconsultants. Thisprovisionappliesregardlessof whetheror not theCity hasreceivedawaiverof subrogationendorsementfromtheinsurer.
DeductiblesandSelf-InsuredRetentions
Anydeductibleorself-insuredretentionmustbedeclaredtoandapprovedbytheCity. At City’soption, either:
theinsurermustreduceor eliminatethedeductibleor self-insuredretentionsasrespectstheCity/Additional Insureds; or Consultantmustshowproof of ability to pay lossesandcostsrelatedinvestigations, claim administrationanddefenseexpenses. Thepolicyshallprovide, orbeendorsedtoprovide, thattheself-insured retentionmaybesatisfiedby eithertheinsuredor theCity.
Acceptabilityof Insurers
Insurersmustbelicensedto dobusinessin Californiawith anA.M. BestRatingof A-VII, or better.
Verification of Coverage
Consultantmustfurnishacceptableinsurancecertificatesandmandatoryendorsements (orcopiesof thepolicies effectingthecoveragerequiredbythisContract), andacopyof theDeclarationsandEndorsementPageof the CGL policylistingall policyendorsementsprior to commencementof theContract. City retainstherightto demandverificationof complianceatanytimeduringtheContractterm.
Subconsultants
Consultantshallrequireandverify thatall subconsultantsmaintaininsurancethatmeettherequirementsof thisContract, includingnamingtheCity asanadditionalinsuredonsubconsultant’sinsurancepolicies.
HigherInsuranceLimits
If Consultantmaintainsbroadercoverageand/orhigherlimitsthantheminimumsshownabove, Cityshallbe entitledto coveragefor thehigherinsurancelimits maintainedby Consultant.
Adequacyof Coverage
City reservestherightto modifytheseinsurancerequirements/coveragebasedonthenatureof therisk, prior experience, insureror otherspecialcircumstances, with notlessthanninety (90) dayspriorwrittennotice.