1 THIRD AMENDMENT TO AGREEMENT 539 BETWEEN THE CITY OF CUPERTINO AND
HINDERLITER, DE LLAMAS & ASSOCIATES FOR SALES, USE AND TRANSACTIONS
TAX AUDIT SERVICES
This Third Amendment to Agreement 539 betweenthe City of Cupertino and HINDERLITER, DE LLAMAS & ASSOCIATES is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and HINDERLITER, DE LLAMAS & ASSOCIATES, a Limited Liability Company (“ Contractor”) whose address is 120 S. STATE COLLEGE BLVD., SUITE 200, BREA, CA 92821, and is madewith referenceto the following:
RECITALS:
A. On July 08, 2020 Agreement 539 (“ Agreement”) was entered into by and between City and Contractor for Sales, Use and TransactionsTax Audit Services.
B. On June28, 2022 the City and Contractor enteredthe First Amendment with a term expiring on June 30, 2023.
C. On August 02, 2022, the City and Contractor entered the Second Amendment to add confidentiality requirements.
D. The Original Agreement and First Amendment are collectively referred to as Agreement” unless otherwise indicated.
E. 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 the undersigned parties as follows:
1. Section #3.1 of the Agreement is modified to read asfollows: TIME OF PERFORMANCE.
Term. This Agreement begins on the Effective Date and endson June30, 2026 (“Contract Time”), unless terminated earlier as provided herein. The City’ s appropriate department heador the City Manager may extend the Contract Time through a written amendmentto this Agreement, provided such extensions does not include additional contract funds.
Extensions requiring additional contract funds are subject to the City’s purchasing policy.
2. Section #4 of the Agreement is modified to read asfollows: COMPENSATION Section 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Servicesa total amount that will basedon actual costsbut that will be capped so as not to exceed $ 170, 000. 00 (“ Contract Price”), based upon the scope of servicesin Exhibit A and the budget and ratesincluded, Compensationattachedand incorporated here. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costsexceedthe cappedamount. No extra work or payment is permitted without prior written approval of City. 2 3. Except asexpressly modified herein, all other terms and covenantsset forth in the Agreement shall remain the sameand shall be in full force andeffect.
IN WITNESS WHEREOF, the parties hereto have caused this 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 &
ASSOCIATES
By
Title
Date
President
06/ 02/ 23
Director of Administrative Services
06/ 02/ 23
Christopher D. Jensen
06/ 02/ 23
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.
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
5/25/ 2023
Woodruff Sawyer
2 Park Plaza, Suite 500
Irvine CA 92614
WS Certificates
844- 872- 6329
certificates@woodruffsawyer. com
Berkley National Insurance Company 38911
HDLCOMP- 01 Hudson Excess Insurance Company
14484HinderliterdeLlamas&Associates
HdL Software, LLC.
120 S. State College Blvd, Suite 200
Brea, CA 92821
2068396522
A X 1,000, 000
X 1,000, 000
15, 000
1,000, 000
2,000, 000
X
Y Y TCP702275410 5/26/ 2023 5/26/ 2024
2,000, 000
A 1,000, 000
X
Y Y TCP702275410 5/26/ 2023 5/26/ 2024
A X X 5,000,000TCP7022754105/ 26/ 2023 5/26/ 2024
5,000, 000
X None
B
B
B
Professional Liability
Cyber Liability
Tech E& O
EET 14167 01
EET 14167 01
EET 14167 01
5/26/ 2023
5/26/ 2023
5/26/ 2023
5/26/ 2024
5/26/ 2024
5/26/ 2024
Prof Liab Agg
Cyber Limit
Tech E& O Limit
2,000, 000
2,000, 000
2,000, 000
Retroactive Date for Professional Liability- 2/15/ 2013.
Line Of Coverage: Crime
Policy # 82556901
Effective Date 5/25/ 2023 - 5/26/ 2024
Carrier: Federal Insurance Company NAIC # 20281
Crime Limit:$ 1,000, 000
See Attached...
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
10300 Torre Avenue
Cupertino CA 95014
ACORD 101 ( 2008/ 01)
The ACORD name and logo are registered marks of ACORD
2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
HDLCOMP- 01
1 1
Woodruff Sawyer Hinderliter de Llamas & Associates
HdL Software, LLC.
120 S. State College Blvd, Suite 200
Brea, CA 92821
25 CERTIFICATE OF LIABILITY INSURANCE
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are included as Additional Insured as respects General Liability and Automobile Liability on a Primary and Non- contributory basis with a waiver of subrogation to the extent provided in the attached forms. Notice of Cancellation applies with respects General Liability to the extent provided in the attached form.
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 02 24 10 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 02 24 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 oo
EARLIER NOTICE OF CANCELLATION
PROVIDED BY US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Number of Days' Notice
If no entry appears above, information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement.)
For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above.
30 TCP702275410
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 10300 Torre Avenue
Cupertino
CA
95014
CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 9 of 12
4. Loss Payment – Physical Damage
Coverages
At our option, we may:
a. Pay for, repair or replace damaged or
stolen property;
b. Return the stolen property, at our expense.
We will pay for any damage that results to
the " auto" from the theft; or
c. Take all or any part of the damaged or
stolen property at an agreed or appraised
value.
If we pay for the " loss", our payment will
include the applicable sales tax for the
damaged or stolen property.
5. Transfer Of Rights Of Recovery Against
Others To Us
If any person or organization to or for whom we
make payment under this Coverage Form has
rights to recover damages from another, those
rights are transferred to us. That person or
organization must do everything necessary to
secure our rights and must do nothing after
accident" or " loss" to impair them.
B. General Conditions
1. Bankruptcy
Bankruptcy or insolvency of the " insured" or the
insured' s" estate will not relieve us of any
obligations under this Coverage Form.
2. Concealment, Misrepresentation Or Fraud
This Coverage Form is void in any case of
fraud by you at any time as it relates to this
Coverage Form. It is also void if you or any
other " insured", at any time, intentionally
conceals or misrepresents a material fact
concerning:
a. This Coverage Form;
b. The covered " auto";
c. Your interest in the covered " auto"; or
d. A claim under this Coverage Form.
3. Liberalization
If we revise this Coverage Form to provide
more coverage without additional premium
charge, your policy will automatically provide
the additional coverage as of the day the
revision is effective in your state.
4. No Benefit To Bailee – Physical Damage
Coverages
We will not recognize any assignment or grant
any coverage for the benefit of any person or
organization holding, storing or transporting
property for a fee regardless of any other
provision of this Coverage Form.
5. Other Insurance
a. 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:
1) Excess while it is connected to a motor
vehicle you do not own; or
2) Primary while it is connected to a
covered " auto" you own.
b. 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".
c. 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".
d. 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.
6. Premium Audit
a. 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.
b. 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 NUMBER: COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 04 44 10 13 © 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.
TCP702275410
Hinderliter de Llamas & Associates
05/ 26/ 2023
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 10300 Torre Avenue
95014CACupertino
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 24 04 12 19 © Insurance Services Office, Inc., 2018 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:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name Of Person( s) Or Organization( s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:
We waive any right of recovery against the person( s)
or organization( s) shown in the Schedule above
because of payments we make under this Coverage
Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against
such person( s) or organization( s) prior to loss. This endorsement applies only to the person( s) or
organization( s) shown in the Schedule above.
TCP702275410
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 10300 Torre Avenue
Cupertino 95014CA
POLICY NUMBER: COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 20 48 10 13 © 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.
TCP702275410
Hinderliter de Llamas & Associates
05/ 26/ 2023
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 95014CACupertino10300TorreAvenue
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person( s) Or Organization( s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to
include as an additional insured the person( s) or
organization( s) shown in the Schedule, but only
with respect to liability for " bodily injury", " property damage" or " personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
TCP702275410
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 10300 Torre Avenue
Cupertino
CA
95014
05/ 30/ 2023
Marsh Affinity
a division of Marsh USA LLC.
PO BOX 14404
Des Moines, IA 50306- 9686
Marsh Affinity
800- 743- 8130
ADPTotalSource@marsh. com
AIU Insurance Company 19399
A
07/ 01/ 2023 07/ 01/ 2024
2, 000, 000
2, 000, 000
2, 000, 000
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 92821
WC 034279274CAX
All worksite employees working for Hinderliter de Llamas & Associates paid under ADP TOTALSOURCE, INC.' s payroll, are covered under the above stated policy. WAIVER OF SUBROGATION IN FAVOR OF The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers AS RESPECTS OF JOB PERFORMED BY Hinderliter de Llamas & Associates AS REQUIRED BY WRITTEN CONTRACT.
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
10300 Torre Avenue
Cupertino, CA 95014
X
WAIVER OF SUBROGATION IN FAVOR OF The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers AS RESPECTS OF JOB PERFORMED BY Hinderliter de Llamas & Associates AS REQUIRED BY WRITTEN CONTRACT.
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
10300 Torre Avenue
Cupertino, CA 95014
07/ 01/ 2023 WC 034279274 CA
AIU Insurance Company
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 92821