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23-028 CSG Consultants Blackberry Farm Pole Inspection – Year 3Blackberry Farm Pole Inspection – Year 3
Page 1 of 9 Professional/Consulting Contracts /Version: October 2021
PROFESSIONAL/CONSULTING SERVICES AGREEMENT
1. PARTIES
This Agreement is made by and between the City of Cupertino, a municipal corporation (“City”),
and CSG Consultants Inc. (“Contractor”), a Corporation for Blackberry Farm Pole Inspection –
Year 3, 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 December 30, 2023 (“Contract
Time”), unless terminated earlier as provided herein. Contractor’s Services shall begin on the
effective date and shall be completed by December 30, 2023. 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 B.
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
$2,640.00 (“Contract Price”), based upon the scope of services in Exhibit A and the budget and
rates included in Exhibit C, 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 payment requisition
relieves City of any further payment or other obligations under the Agreement.
5. INDEPENDENT CONTRACTOR
5.1 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.
5.2 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.
5.3 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.
5.4 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.
5.5 Tools, Materials, and Equipment. Contractor will supply all tools, materials and
equipment required to perform the Services under this Agreement.
5.6 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, p ersonal 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 confiden tial 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 Contracto r 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.
7.3 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 D, 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 Jimmy Tan 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 Nourdin Khayata, PE
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 ever y 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. NOTICES
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: Jimmy Tan
Email: JimmyT@cupertino.org
To Contractor:
CSG Consultants Inc
550 Pilgrim Dr.
Foster City, CA 94404
Attention: Nourdin Khayata, PE
Email: nourdin@csgengr.com
27. EXECUTION
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 CONTRACTOR
A Municipal Corporation
By By
Name Name
Title Title
Date Date
nourdinkhayata
nourdinkhayata
Vice President
Apr 13, 2023
Jimmy Tan, P.E.
Assistant Director of Public Works
Apr 13, 2023
Blackberry Farm Pole Inspection – Year 3
Page 9 of 9 Professional/Consulting Contracts /Version: October 2021
APPROVED AS TO FORM:
CHRISTOPHER D. JENSEN
Cupertino City Attorney
ATTEST:
KIRSTEN SQUARCIA
City Clerk
Date
Christopher D. Jensen
Apr 13, 2023
550 Pilgrim Drive
Foster City, CA 94404
phone 650.522.2500
fax 650.522.2599
www.csgengr.com
FOSTER CITY | PLEASANTON | SAN JOSE | SACRAMENTO | NEWMAN | FRESNO | PASO ROBLES | ORANGE
February 1, 2023
Jimmy Tan, PE
Assistant Director of Public Works - Operations
10300 Torre Avenue
Cupertino, CA 95014
Re: Blackberry Farm Pole Inspection – Year 3
CSG Consultants, Inc. (CSG) is pleased to present this proposal to the City of Cupertino (City) to provide
building and engineering services for the above referenced project (project).
SCOPE OF WORK
We understand the project scope involves providing assessment of 13 existing wood poles at Black Berry
Farm Golf Course to determine their structural integrity. We foresee the following tasks as part of this scope
of work:
• Perform site visit to observe poles
• Analyze field data and develop a report
• Present report and address questions regarding findings
*Site observations will include limited testing of poles: Tools used will be a hammer and metal probe for
soundness and penetration tests within 1-inch of the surface of the poles
• Observe the soil or rock around the pole at the base
• Condition of wood decay or damage within six inches of the base
• Penetration tests near the bottom six inches of each pole
• Penetration test near the height of approximately 4 feet
• Observe and estimate the width of the vertical splits due to wood shrinkage
• Observe the extent or length of the of vertical splits along the height of the pole
• Compare current findings with previous inspection findings
PROPOSED STAFF
For this project, CSG proposes Nourdin Khayata as the main point of contact. His contact info is as follows:
Nourdin Khayata, PE | VP, Construction Management
(650) 522-2524 Office | nourdin@csgengr.com E-Mail
Conducting the assessment will be Bounmy Soumountha, SE. He brings has over 38 years of experience in
civil and structural engineering analysis and building inspection plan review and permit services. Bounmy
performed the assessment for this project previously. Phiroze Wadia, SE, will provide QA/QC for this project.
Their resumes are attached at the end of this proposal.
COST
CSG stands ready to provide the building and engineering services for this project. Provided below is the
proposed fee.
Role Hourly Rate Hours Cost
Senior Structural Engineer $220 12 $2,640
Total Cost $2,640
We look forward to working with the City of Cupertino on this project. If you have any questions regarding our
proposal, please contact Mr. Khayata at (650) 522-2524.
Sincerely,
Nourdin Khayata, PE
Vice President, Construction Management
Exhibit A and C
Bounmy
LICENSES & CERTIFICATIONS
Professional Civil Engineer
State of California | 32213
Structural Engineer
State of California | 3062
Certified Building Official
EDUCATION
Master of Science
Structural Engineering
Washington University | St. Louis, MO
Bachelor of Science, Civil Engineering
UC Berkeley| Berkeley, CA
A.S., Engineering
Santa Rosa Junior College
Santa Rosa, CA
PROFESSIONAL AFFILIATIONS
Structural Engineers’ Association of
Northern California
California Building Officials
Soumountha SE, CBO
Senior Structural Engineer
Mr. Soumountha has over 38 years of experience in civil and structural engineering analysis,
public works engineering and land development, project development review and approval,
and building inspection plan review and permit services. He managed hundreds of projects in
his 22 years of service at the City of Santa Clara including the 49ers Stadium, large
development projects such as the Gallery at Central Park consisting of 500 plus single family
and multifamily buildings and other projects worth more than 200 million dollars of all
complexities in terms of fire and life safety and structural engineering systems.
RELEVANT EXPERIENCE
Permit Service Manager | City of Santa Clara, CA
Prior to joining CSG, Mr. Soumountha worked as a Permit Service Manager and managed 3 in-
house and outside consultant Plan Check Engineers who were licensed civil and structural
engineers, 3 Permit Technicians, and 1 Customers’ Representative. He supported and acted on
behalf of the Building Official for all functions as assigned or in the Building Official’s absence.
Senior Plans Examiner | City of Santa Clara, CA
Mr. Soumountha served as Senior Plans Examiner where he verified, reviewed, inspected and
approved construction of all commercial, industrial, and residential structures in the City of
Santa Clara, with an annual construction volume valued at over $500 million. His other
responsibilities included: comprehensive review of all structural and life-safety aspects of
building construction; providing code interpretation to inspection staff, architects and
contractors; responding to city council inquiries in matters of urban planning and zoning
issues; and assisting in supervision of Building Inspection staff as assigned.
City Engineer I & II | City of Santa Clara, CA
As City Engineer II, Mr. Soumountha supervised the Title Section of the Land and Property
Division of the Engineering Department. Some of his responsibilities included:
• Assisting in the formation of assessment districts and redistribution of surplus assessment
district funds
• Reviewing and processing agreements for developments for City departments such as
Silicon Valley Powers (the City Electric Department)
• Permitting encroachments into public easements and right-of-ways
• Parcel and final maps inspection for the legal subdivision of private and public properties
• Preparing the Engineering Department operating budget for 5 years
Structural Engineering Designer and Code Consultant | Various Jurisdictions
• Since 1980, prior to his service at the City of Santa Clara, Mr. Soumountha provided
structural analysis and design, consultation on construction issues, and code
consulting services for numerous projects outside of City of Santa Clara jurisdiction.
Phiroze
LICENSES & CERTIFICATIONS
Professional Structural Engineer
State of California | 2020
Professional Civil Engineer
State of California | 20042
Professional General Building Contractor
State of California | 5021918
LEED Accredited Professional
EDUCATION
M.S.C.E, Structures and Soil Mechanics
University of Illinois | Urbana, Il
M.B.A, Management
Golden Gate University |
San Francisco, CA
PROFESSIONAL
AFFILIATIONS
American Society of Civil Engineers
Structural Engineers Association
of California
Earthquake Engineering
Research Institute
Applied Technology Committee
International Code Council
Wadia SE, LEED AP
Principal Structural Engineer
Mr. Wadia is a plan review engineer for CSG. He has over 40 years of experience in plan
review, design and construction of residential, commercial, industrial and civil engineering
projects. Mr. Wadia has expertise in the delivery of a wide range of municipal services,
including:
• Plan review
• Encroachment permit application review including grading, structural, drainage and
erosion control permits
• Code enforcement
• Enhancing and developing new and existing City ordinances
• Supervising renovation, rehabilitation and restoration of bridges
• Inspecting buildings and structures for structural integrity and condition
• Investigating structural failures and inspecting repairs
RELEVANT EXPERIENCE
Mr. Wadia’s range of expertise has evolved as a result of the successful completion of a variety
of projects including:
• 24 commercial buildings
• 60 residential wood frame buildings
• 32 seismic inspections, evaluations &
retrofits
• 3 bridge and over-crossings projects
• 8 post-earthquake damage assessments
• 9 offshore, modular & Arctic projects
• 4 space & defense projects
• 3 war damaged re-construction
projects
• 8 petrochemical plants
• 10 nuclear/power plants
• 8 research projects
• 5 transportation projects
• 2 telecommunications projects
Plan Review Engineer | Consultant to City of Larkspur, City of Sausalito, Town of Ross, Town
of San Anselmo, CA
As Consultant to the abovementioned agencies in Marin County, Mr. Wadia performed a
variety of services including plan and encroachment permit application review, inspection,
code enforcement, and enhancing and developing existing and new city ordinances.
Associate | Skidmore, Owings & Merrill, San Francisco, CA
As an Associate at a San Francisco architectural and engineering firm, Mr. Wadia worked
closely with multidisciplinary teams on building designs from concept through construction.
He led structural engineering projects including high-rise office buildings, schools and colleges,
hotels, sports stadiums, theaters, retirement communities, and shopping centers. Mr. Wadia
also performed seismic inspections, evaluations, and retrofits of existing facilities.
Chief Engineer | Bechtel, San Francisco, CA
As Chief Engineer of Bechtel, Mr. Wadia was responsible for leading a group of over 200
technical personnel including architects, structural engineers, civil engineers and designers.
His work included establishing standards, reviewing technical quality, recruiting, and
establishing training programs. His projects included bridges and industrial and mining
facilities such refineries, oil fields, LNG plants, chemical waste treatment plants, offshore
construction, modularized construction, arctic and extreme hot weather construction, space
launch facilities, solar and geothermal power plants, and nuclear facilities.
Exh. D-Insurance Requirements for Design Professionals & Consultant Contracts
1
Form Updated Jan. 2022
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. Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for
premises operations, products and completed operations, contractual liability, and personal and
advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a
general aggregate limit applies, either the general aggregate limit shall apply separately to this
project/location (ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrence limit.
a. It shall be a requirement that any available insurance proceeds broader than or in excess of the
specified minimum insurance coverage requirements and/or limits shall be made available to the
Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the
broader coverage and maximum limits of coverage of any insurance policy, whichever is greater.
b. Additional Insured coverage under Consultant's policy shall be "primary and non-contributory,"
will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO
Form CG 20 10 (04/13).
c. The limits of insurance required may be satisfied by a combination of primary and umbrella or
excess insurance, provided each policy complies with the requirements set forth in this Contract. Any
umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage
shall also apply on a primary basis for the benefit of City before the City’s own insurance or self-
insurance shall be called upon to protect City as a named insured.
2. Automobile Liability: ISO CA 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 or disease.
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 five (5) years after completion of the Services.
c. 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 five (5) years after completion of the Services.
EXHIBIT D
Insurance Requirements
Design Professionals & Consultants Contracts
Exh. D-Insurance Requirements for Design Professionals & Consultant Contracts
2
Form Updated Jan. 2022
OTHER INSURANCE PROVISIONS
The aforementioned insurance shall be endorsed and have all the following conditions and provisions:
Additional Insured Status
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
(“Additional Insureds”) are to be covered as additional insureds on Consultant’s CGL and automobile
liability policies. General Liability coverage can be provided in the form of an endorsement to Consultant’s
insurance (at least as broad as ISO Form CG 20 10 (11/ 85) or both CG 20 10 and CG 20 37 forms, if later
editions are used).
Primary Coverage
Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance
maintained by City, its officers, officials, employees, or volunteers shall be excess of Consultant’s insurance
and shall not contribute to it.
Notice of Cancellation
Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written
notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums.
Waiver of Subrogation
Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the
extent said losses are covered by the insurance policies required herein. Specifically, the Workers’
Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed
by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not
the City has received a waiver of subrogation endorsement from the insurer.
Deductibles and Self-Insured Retentions
Any deductible or self-insured retention must be declared to and approved by the City. At City’s option, either:
the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional
Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim
administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self-insured
retention may be satisfied by either the insured or the City.
Acceptability of Insurers
Insurers must be licensed to do business in California with an A.M. Best Rating of A-VII, or better.
Verification of Coverage
Consultant must furnish acceptable insurance certificates and mandatory endorsements (or copies of the policies
effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the
CGL policy listing all policy endorsements prior to commencement of the Contract. City retains the right to
demand verification of compliance at any time during the Contract term.
Subconsultants
Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements of
this Contract, including naming the City as an additional insured on subconsultant’s insurance policies.
Higher Insurance Limits
If Consultant maintains broader coverage and/or higher limits than the minimums shown above, City shall be
entitled to coverage for the higher insurance limits maintained by Consultant.
Adequacy of Coverage
City reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior
experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice.
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
E-MAIL
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER:$
COMBINED SINGLE LIMIT
$(Ea accident)
ANY AUTO BODILY INJURY (Per person)$
OWNED SCHEDULED
BODILY INJURY (Per accident)$AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
$
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
12/20/2022
License # 0C36861
21873
CSG Consultants, Inc.
550 Pilgrim Drive
Foster City, CA 94404
21849
21881
10046
A 1,000,000
X X USC032768220 12/4/2022 12/4/2023 100,000
10,000
1,000,000
2,000,000
2,000,000
1,000,000B
X X SCV013084-22-01 12/4/2022 12/4/2023
5,000,000A
X X USC029989221 12/4/2022 12/4/2023 5,000,000
10,000
C
X SCW023953-22-01 12/4/2022 12/4/2023 1,000,000
1,000,000
1,000,000
D Professional Liab.X 83 OH 0489503-22 12/4/2022 Ded: $50,000; Agg:5,000,000
D Retro Date: 1/1/1991 83 OH 0489503-22 12/4/2022 12/4/2023 Occurrence:5,000,000
Re: City of Cupertino, its City Council, boards and commissions, officers, employees and volunteers are included as additional insureds on GL & Auto with
Waiver of Subrogation and 30 Day Notice of Cancellation per attached. Waiver of Subrogation on WC and 30 Day Notice of Cancellation on Professional per
attached. 30 Day Notice of Cancellation on WC is not available. Waiver of Subrogation on Professional applies.
City of Cupertino
10300 Torre Avene
Cupertino, CA 95014
CSGCONS-01 TWANG
Alliant Insurance Services, Inc.
560 Mission St 6th Fl
San Francisco, CA 94105
Melissa Hill
Melissa.Hill@alliant.com
Fireman's Fund Insurance Company
American Automobile Insurance Company
National Surety Corporation
Pacific Insurance Company, Limited
X
12/4/2023
X
X
X
X
X
X
X
MultiCover® - Without Medical Payments - CG 71 93 03 19
Policy Amendment(s) Commercial General Liability Coverage Form
Your Commercial General Liability Coverage Form is revised as follows:
1. Broadened Named Insured
A. SECTION II - WHO IS AN INSURED, item 3., is deleted and replaced by the following:
3. Any organization that you own at the inception of this policy, or newly acquire or form during the policy
period, and over which you maintain during the policy period majority ownership or majority interest,
will qualify as a Named Insured if:
a. There is no other similar insurance available to that organization; and
b. The first Named Insured shown in the Declarations has the responsibility of placing insurance for
that organization; and
c. That organization is incorporated or organized under the laws of the United States of America.
However:
(1) Coverage under this provision 3 is afforded only until the next occurring annual anniversary of the
beginning of the policy period shown in the Declarations, or the end of the policy period, whichever
is earlier; and
(2) Coverage A does not apply to bodily injury or property damage that occurred before you acquired
or formed the organization; and
(3) Coverage B does not apply to personal and advertising injury arising out of an offense committed
before you acquired or formed the organization.
B. SECTION II - WHO IS AN INSURED, the last paragraph, is deleted and replaced by the following:
No person or organization is an insured with respect to the conduct of any current or past partnership, joint
venture, or limited liability company that is not shown as a Named Insured in the Declarations. However,
this does not apply to a limited liability company that meets all of the conditions in Section II - Who Is An
Insured, item 3., above.
2. Additional Insured
If an Additional Insured endorsement is attached to this policy that specifically names a person or organization
as an additional insured, then this Section 2. Additional Insured does not apply to such person or organization.
SECTION II - WHO IS AN INSURED, subsection 2.e., is added as follows:
e. Any person or organization is included as an additional insured, but only to the extent such person or
organization is legally obligated to pay for bodily injury, property damage or personal and advertising
injury caused by your acts or omissions. With respect to the insurance afforded to such additional insured,
all of the following additional provisions apply:
(1) You have agreed in a written insured contract that such person or organization be added as an
additional insured under this policy;
(2) The bodily injury, property damage or personal and advertising injury for which said person or
organization is legally obligated to pay occurs subsequent to the execution of such insured contract;
(3) The most we will pay is the lesser of either the amount of insurance available under the applicable Limits
of Insurance shown in the Declarations or the limits of insurance required by the insured contract;
(4) The insurance afforded to such additional insured only applies to the extent permitted by law;
Policy Number: USC032778220
(5) Such person or organization is an additional insured only with respect to:
(a) Their ownership, maintenance, or use of that part of the premises, or land, owned by, rented to,
or leased to you, except such person or organization is not an insured with respect to structural
alterations, new construction or demolition operations performed by or on behalf of such person
or organization;
(b) Your ongoing operations performed for that insured;
(c) Their financial control of you, except such person or organization is not an insured with respect to
structural alterations, new construction or demolition operations performed by or on behalf of such
person or organization;
(d) The maintenance, operation or use by you of equipment leased to you by such person or
organization;
(e) Operations performed by you or on your behalf and for which a state or political subdivision has
issued a permit, provided such operations are not performed for such state or political subdivision,
and are not included within the products-completed operations hazard; or
(f) Their liability as a grantor of a franchise to you.
(6) This insurance does not apply to bodily injury, property damage, personal and advertising injury,
occurrence or offense:
(a) Which takes place at a particular premises after you cease to be a tenant of that premises;
(b) Which takes place after all work, including materials, parts or equipment furnished in connection
with such work to be performed by or on behalf of the additional insured at the site of the covered
operations, has been completed;
(c) Which takes place after that portion of your work out of which the injury or damage arises has
been put to its intended use by any other person or organization other than another contractor or
subcontractor engaged in performing operations for a principal as part of the same project; or
(d) Which takes place after the expiration of any equipment lease to which (4)(d) above applies;
(7) With respect to architects, engineers or surveyors, coverage does not apply to bodily injury, property
damage or personal and advertising injury arising out of the rendering or failure to render any
professional services by or for you, including:
(a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders, or drawings and specifications; or
(b) Supervisory, inspection, architectural, or engineering services.
These exclusions apply even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the occurrence which caused
the bodily injury or property damage, or the offense which caused the personal or advertising injury, involved
the rendering of or the failure to render any professional services by or for you.
3. Additional Insured - Vendors
If an Additional Insured Vendors endorsement is attached to this policy that specifically names a person or
organization as an additional insured, then this Section 3. Additional Insured - Vendors does not apply to that
person or organization.
Unless the products-completed operations hazard is excluded from this policy, SECTION II - WHO IS AN
INSURED, item 2.f. is added as follows:
f. Any vendor of yours is included as an additional insured, but only with respect to bodily injury or property
damage caused by your products which are distributed or sold in the regular course of the vendor’s
business, subject to the following additional exclusions:
Policy Number: USC032778220
(1) The insurance afforded such vendor does not apply to:
(a) Bodily injury or property damage for which the vendor is obligated to pay damages by reason of
the assumption of liability in a contract or agreement. This exclusion does not apply to liability for
damages that the vendor would have in the absence of the contract or agreement;
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the product made intentionally by the vendor;
(d) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the
substitution of parts under instructions from the manufacturer, and then repackaged in the original
container;
(e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed
to make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of the products;
(f) Demonstration, installation, servicing or repair operations, except such operations performed by
the vendor in full compliance with the manufacturer’s written instructions at the vendor’s premises
in connection with the sale of the product;
(g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or ingredient of any other thing or substance by or for the vendor; or
(h) Bodily injury or property damage arising out of the liability of the vendor for its own acts or
omissions or those of its employees or anyone else acting on its behalf.
(2) This insurance does not apply to any insured person or organization from whom you have acquired such
products or any ingredient, part or container, entering into, accompanying or containing such products;
(3) The most we will pay is the lesser of either the amount of insurance available under the applicable
Limits of Insurance shown in the Declarations or the limits of insurance required by the contract or
agreement; and
(4) The insurance afforded to such vendor only applies to the extent permitted by law.
4. Additional Insured - Limited Primary and Noncontributory Provision
The following is added as a second paragraph to Section IV Conditions, Condition 4. Other Insurance, following
paragraph b.(2):
However, if you have added any person, organization or vendor of yours as an additional insured to this policy
by way of this MultiCover® endorsement and have agreed in a written insured contract that this insurance is
primary and non-contributory with other insurance available to that additional insured, this insurance is primary
and we will not seek contribution from such additional insured’s other insurance, provided that the additional
insured is a Named Insured under such other insurance.
5. Waiver of Subrogation
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 8., is deleted and replaced by the
following:
8. Transfer of Rights of Recovery Against Others to Us and Blanket Waiver of Subrogation
a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part,
those rights are transferred to us. The insured must do nothing after the loss to impair those rights. At
our request, the insured will bring suit or transfer those rights to us and help us enforce them.
b. If required by a written insured contract executed prior to the occurrence or offense, we waive any
right of recovery we may have against any person or organization named in such insured contract,
because of payments we make for injury or damage arising out of your operations or your work for
that person or organization.
Policy Number: USC032778220
6. Cancellation - 90 Days
Common Policy Conditions endorsement IL0017, A. Cancellation, item 2.b. is deleted and replaced by the
following:
b. 90 days before the effective date of cancellation if we cancel for any other reason.
7. Liberalization
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added as an additional
Condition:
Liberalization
If we adopt a change in our forms or rules which would broaden the coverage provided by any form that is a part
of this policy without an extra premium charge, the broader coverage will apply to this policy. This extension is
effective upon the approval of such broader coverage in your state.
8. Fire, Explosion, Sprinkler Leakage, or Lightning Legal Liability Coverage
A. SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2.
Exclusions, the last paragraph, is deleted and replaced by the following:
Exclusions c. through n. do not apply to damage by fire, explosion, sprinkler leakage, or lightning to premises
while:
1. Rented to you;
2. Temporarily occupied by you with the permission of the owner; or
3. Managed by you under a written agreement with the owner.
A separate limit of insurance applies to this coverage as described in Section III - LIMITS OF INSURANCE.
B. SECTION III - LIMITS OF INSURANCE, item 6., is deleted and replaced by the following:
6. Subject to 5. above, the Damage to Premises Rented To You Limit shown in the Declarations, for
property damage to any one premises while rented to you, or in the case of damage by fire, explosion,
sprinkler leakage, or lightning while rented to you, temporarily occupied by you with the permission of
the owner, or managed by you under a written agreement with the owner, is the greater of:
a. $1,000,000 Any One Premises; or
b. The Damage To Premises Rented To You Limit shown in the Declarations.
C. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, b. Excess
Insurance, (1)(a), items (i) and (iii), are deleted and replaced by the following:
(i) That is Fire, Explosion, Sprinkler Leakage or Lightning insurance for premises while rented to you,
temporarily occupied by you with permission of the owner, or managed by you under a written agreement
with the owner;
(iii) That is insurance purchased by you to cover your liability as a tenant for property damage to premises
rented to you, temporarily occupied by you with the permission of the owner, or managed by you under
a written agreement with the owner; or
D. SECTION V - DEFINITIONS, 9. Insured Contract, item a., is deleted and replaced by the following:
(a) A contract for a lease of premises. However, that portion of the contract for a lease of premises that
indemnifies any person or organization for damage by fire, explosion, sprinkler leakage, or lightning to
premises while rented to you, temporarily occupied by you with permission of the owner, or managed
by you under a written agreement with the owner, is not an insured contract;
9. Damage to Invitees’ Automobiles from Falling Trees or Tree Limbs - Limited Coverage
Policy Number: USC032778220
This coverage applies to direct physical damage to automobiles owned by invitees subject to all of the following:
1. Provided such damage originates from trees on premises owned, managed, leased or rented by an insured;
2. Coverage applies only to invitees of an insured or an insured’s tenant;
3. Such damage is directly caused by wind-driven falling trees or tree limbs;
4. The most we will pay for any one loss is the lowest of:
a. the actual cash value of the damaged automobile as of the time of the loss; or
b. the cost of repairing the damaged automobile; or
c. the cost of replacing the damaged automobile with another automobile of like kind and quality.
Regardless of the number of occurrences, losses or claims, this coverage is subject to a limit of $25,000
in any one policy period;
5. This coverage is not subject to the General Liability General Aggregate Limit; and
6. We will make payments under this coverage without regard to fault.
10. Non-Owned or Chartered Watercraft
SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2.
Exclusions, item g. Aircraft, Auto, or Watercraft, item (2), is deleted and replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than 51 feet long; and
(b) Not being used for public transportation or as a common carrier;
11. Chartered Aircraft
SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2.
Exclusions, g. Aircraft, Auto Or Watercraft, item (6), is added as follows:
(6) An aircraft in which you have no ownership interest and that you have chartered with crew.
12. Coverage Territory - Broadened
SECTION V - DEFINITIONS, item 4.a., is deleted and replaced by the following:
a. The United States of America (including its territories and possessions), Puerto Rico, Canada, Bermuda,
the Bahamas, The Cayman Islands and the British Virgin Islands;
13. Personal and Advertising Injury - Contractual
Unless personal and advertising injury is excluded from this policy the following applies:
SECTION I - COVERAGES, COVERAGE B, 2. Exclusions, item e., is deleted.
14. Fellow Employee Coverage
SECTION II - WHO IS AN INSURED, 2.a., item (1) is deleted and replaced by the following:
(1) Personal and advertising injury:
However, subsections (a), (b), (c) and (d) of item (1) remain unchanged.
15. Bodily Injury Definition - Broadened
SECTION V - DEFINITIONS, 3. Bodily Injury is deleted and replaced by the following:
Bodily injury means bodily injury, sickness or disease sustained by a person including death or mental anguish
resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease.
16. Expected or Intended Injury - Amendment to Exclusion
Policy Number: USC032778220
SECTION I. Coverage A Bodily Injury and Property Damage Liability, 2. EXCLUSIONS, a. Expected or Intended
Injury, is deleted and replaced by the following:
a. Expected or Intended Injury
Bodily injury or property damage expected or intended from the standpoint of the insured.
This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable
force to protect persons or property.
17. Unintentional Failure to Disclose Hazards
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 6. Representations, the following is
added:
d. If you unintentionally fail to disclose any hazards existing at the inception date of this policy, we will not deny
coverage under this Coverage Form because of such failure. However, this provision does not affect our
right to collect additional premium or exercise our right of cancellation or non-renewal.
18. Supplementary Payments - Increased Limits
SECTION I - COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGES A AND B, items 1.b. and 1.d., are
deleted and replaced by the following:
b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any
vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds.
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense
of the claim or suit, including substantiated loss of earnings up to $500 a day because of time off from work.
19. Duties in the Event of an Occurrence, Offense, Claim or Suit - Amended
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 2.a. is deleted and replaced by the
following:
(1) You must see to it that we or any licensed agent of ours are notified of a General Liability occurrence or
offense which may result in a claim as soon as practicable after it becomes known to:
(a) You, if you are an individual;
(b) Your partner or member, if you are a partnership or joint venture;
(c) Your member, if you are a limited liability company;
(d) Your executive officer if you are an organization other than a partnership, joint venture or limited liability
company; or
(e) Your authorized representative or insurance manager.
Knowledge of an occurrence or offense by persons other than those listed above does not imply that those
listed above also have such knowledge.
(2) To the extent possible, notice should include:
(a) How, when and where the occurrence or offense took place;
(b) The names and addresses of any injured persons and witnesses; and
(c) The nature and location of any injury or damage arising out of the occurrence or offense.
20. Non Employment Discrimination Liability
Unless personal and advertising injury is excluded from this policy the following applies:
A. SECTION V - DEFINITIONS, 14. Personal and advertising injury, item h. is added as follows:
h. Discrimination.
B. B. SECTION V - DEFINITIONS, item 23. is added as follows:
Policy Number: USC032778220
23. Discrimination means the unlawful treatment of a person or class of persons because of their specific
race, color, religion, gender, age, or national origin in comparison to one or more persons who are not
members of the specified class.
C. SECTION I - COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, 2.
Exclusions, the following are added:
q. Discrimination directly or indirectly related to the past employment, employment or prospective
employment of any person or class of persons by any insured;
r. Discrimination directly or indirectly related to the sale, rental, lease or sublease or prospective sale,
rental, lease or sublease of any dwelling or permanent lodging by or at the direction of any insured;
s. Discrimination, if insurance thereof is prohibited by law; or
t. Fines, penalties, specific performance, or injunctions levied or imposed by a governmental entity,
governmental code, law, or statute because of discrimination.
All other terms and conditions of the policy apply.
Policy Number: USC032778220
Page 1 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
FleetCover® Endorsement – CA 70 18 10 14
Policy Amendment
This Endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A.Broadened Named Insured
Section II – Covered Autos Liability Coverage, A. Coverage, 1. Who Is An Insured, the
following is added:
Any organization you own on the inception of this policy, or newly acquire or form during the
policy period, and over which you maintain during the policy period, majority ownership or
majority interest will qualify as a Named Insured if:
(1)There is no other similar insurance available to that organization; and
(2)The first Named Insured shown in the Declarations of this policy has the responsibility of
placing insurance for that organization; and
(3)The organization is incorporated or organized under the laws of the United States of America.
However:
(a)Coverage under this provision is afforded only until the next occurring 12 month anniversary of
the beginning of the policy period shown in the Declarations, or the end of the policy
period, whichever is earlier; and
(b)Coverage under this provision does not apply to bodily injury or property damage that
results from an accident that occurred before you acquired or formed the organization; and
(c)No person or organization is an insured with respect to any current or past partnership, or
joint venture that is not shown as a Named Insured in the Declarations; and
(d)Coverage under A.(1), (2) and (3) above does not apply to any organization that is covered
as an insured under any other automobile liability insurance policy whose limits of
insurance have been exhausted or whose insurer has become insolvent.
B.Broadened Who Is an Insured
1.Form CA0001 (if attached to this policy), Section II – Covered Autos Liability Coverage, A.
Coverage, 1. Who Is An Insured, item b.(2) is deleted, and d. is added as follows:
d. Your employee while using his owned auto, or an auto owned by a member of his or
her household, in your business or your personal affairs, provided you do not own, hire
or borrow that auto.
2.Form CA0020 (if attached to this policy), Section II – Covered Autos Liability Coverage, A.
Coveraqe, 1. Who Is An Insured, item b.(2) is deleted, and f. is added as follows:
f.Your employee or agent while using his owned private passenger type auto, or a
private passenger type auto owned by a member of his or her household, in your
business or personal affairs, provided you do not own, hire, or borrow that auto.
This form must be attached to Change Endorsement when issued after the policy is written.
One of the Allianz Global Risks US Companies as named in the policy.
Policy Number: SC V 013084 22 01
Page 2 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
C. Additional Insured Coverage and Waiver of Subrogation
1. Form CA0001 (if attached to this policy), Section II – Covered Autos Liability Coverage, A.
Coverage, 1. Who Is An Insured, the following is added as item e.; and form CA0020 (if
attached to this policy), Section II – Covered Autos Liability Coverage, A. Coverage, 1. Who
Is An Insured; the following is added as item g.:
Any person or organization with respect to the operation, maintenance, or use, of a covered
auto, provided that you and such person or organization have agreed under an expressed
provision in a written insured contract or written agreement, or a written permit issued to
you by a governmental or public authority, to add such person, organization, or governmental
or public authority to this policy as an insured.
However, such person or organization is an insured:
(1) Only with respect to the operation, maintenance, or use, of a covered auto; and
(2) Only for bodily injury or property damage caused by an accident which takes place
after:
(a) You executed the insured contract or written agreement; or
(b) The permit has been issued to you.
2. Form CA0001 (if attached to this policy), Section IV - Business Auto Conditions, A. Loss
Conditions, item 5.; and form CA0020 (if attached to this policy), Section V - Motor Carrier
Conditions, A. Loss Conditions, item 6.; the following is added:
Waiver of Subrogation
If required by a:
a. Written insured contract or written agreement executed prior to the accident; or
b. Written permit issued to you by a governmental or public authority prior to the accident;
we waive any right of recovery we may have against any person or organization named in
such contract, agreement or permit, because of payments we make for injury or damage
arising out of the ownership, maintenance or use of a covered auto.
D. Auto Medical Payments - Increased Limit
For each covered auto described in the Declarations or shown in the Schedule as having
Auto Medical Payments Coverage, the Medical Payments Limit of Insurance for those autos is
revised to the greater of:
1. $5,000; or
2. The limit shown in the Declarations.
E. Hired Auto Physical Damage Coverage and Loss of Use Expenses
Hired Auto Physical Damage Coverage
Policy Number: SC V 013084 22 01
Page 3 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
If Physical Damage Coverage is provided by this policy on your owned covered autos, the
following applies:
Any auto that you lease, hire, rent or borrow without a driver, will be covered under this policy
for Physical Damage Coverage. However any such auto:
1. Will be covered only for the same Physical Damage Coverage that applies to your owned
covered autos;
2. Will be subject to the same applicable deductible shown in the Declarations that applies to
your most similar owned covered auto, except any Comprehensive Coverage deductible
does not apply to loss caused by fire or lightning; and
3. The most we will pay for any one loss in any one accident is the lesser of the following:
a. Actual cash value of the damaged or stolen property as of the time of the loss as
determined by us; or
b. The cost of repairing or replacing the damaged or stolen property with other property of
like kind and quality.
In addition, we will pay costs and fees associated with such covered loss only for a maximum
time period of seven days beginning with the date of loss, subject to a maximum of $500.
However:
1. If form CA0001 is attached to this policy, this coverage does not apply to autos you lease,
hire, rent or borrow from any of your employees, partners (if you are a partnership),
members (if you are a limited liability company) or members of their households; and
2. If form CA0020 is attached to this policy, this coverage does not apply to any private
passenger type auto you lease, hire, rent or borrow from any member of your household,
any of your employees, partners (if you are a partnership), members (if you are a limited
liability company), or agents or members of their households.
Hired Auto Loss of Use Expenses
Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage,
4. Coverage Extension, b. Loss of Use Expenses; and form CA0020 (if attached to this policy),
Section IV - Physical Damage Coverage, A. Coverage, 4. Coverage Extension, b. Loss of Use
Expenses; is deleted and replaced by the following:
b. For Hired Auto Physical Damage, we will pay expenses for which an Insured becomes
legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under
a written rental contract or agreement. We will pay for loss of use expenses if caused by:
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is
provided for any covered auto;
(2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss
is provided for any covered auto; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any
covered auto.
Policy Number: SC V 013084 22 01
Page 4 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
However, the most we will pay for any expenses for loss of use is $100 per day, to a
maximum of $1,000.
F. Coverage Territory - Hired Auto
1. Form CA0001, (if attached to this policy), Section IV - Business Auto Conditions, B. General
Conditions, 7. Policy Period, Coverage Territory, b.(5) is deleted and replaced by the following:
(5) 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 180 days or less,
2. Form CA0020 (if attached to this policy), Section V - Motor Carrier Conditions, B. General
Conditions, 7. Policy Period, Coverage Territory, b.(5) is deleted and replaced by the following:
(5) 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 180 days or less,
G. Communication Equipment Coverage
Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, C. Limits of
Insurance, Paragraph 1.b.; and form CA0020 (if attached to this policy), Section IV - Physical
Damage Coverage, C. Limits of Insurance, Paragraph 1.b.; is deleted and replaced by the
following:
b. All electronic equipment that reproduces , receives or transmits audio, visual or data signals in
any one loss is $1,500, if, at the time of loss, such electronic equipment is:
H. Tapes, Records, CDs and DVD Coverage
The P hysical Damage Coverage Section is amended as follows:
1. The exclusion referring to tapes, records, discs, or other similar audio, visual or data
electronic devices designed for use with audio, visual or data electronic equipment does not
apply.
2. Under Comprehensive Coverage - Form CA0001 (if attached to this policy), Section III-
Physical Damage Coverage, A. Coverage; and form CA0020 (if attached to this policy),
Section IV- Physical Damage Coverage, A. Coverage; the following is added:
We will pay for loss to tapes, records, discs or other similar devices used with audio, visual
or data electronic equipment. We will pay only if the tapes, records, discs or other similar
audio, visual or data electronic devices:
a. Are your property, or that of a family member; and
b. Are in a covered auto at the time of a loss.
The most we will pay for loss is $250. No deductible applies to this coverage.
I. Personal Effects Coverage
Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage,
4. Coverage Extensions; and form CA0020 (if attached to this policy), Section IV -
Physical Damage Coverage, A. Coverage, 4. Coverage Extensions; item c. is added as follows:
Policy Number: SC V 013084 22 01
Page 5 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
c. Personal Effects Coverage
We will pay up to $500 for loss for clothing items or other personal effects that are owned
by an insured and are in an Owned auto at the time of a covered loss.
Personal Effects do not include audio visual or electronic devices, money, giftcards, securities,
jewelry, or tools.
This coverage is excess over any other collectible insurance.
No deductible applies to this coverage.
J. Airbag Coverage
1. Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, B.
Exclusions, 3.a.; and form CA0020 (if attached to this policy), Section IV - Physical Damage
Coverage, B. Exclusions, 3.a.; the following is added:
However, mechanical breakdown does not mean the unintended discharge of an airbag,
provided that any loss covered under this provision is excess over any other collectable
insurance or warranty designed to cover such unintended discharge.
K. Rental Reimbursement
Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage,
4. Coverage Extensions; and form CA0020 (if attached to this policy), Section IV - Physical
Damage Coverage, A. Coverage, 4. Coverage Extensions; item d. is added as follows:
d. Rental Reimbursement or Transportation Expenses
If loss occurs to a covered auto described or designated in the Declarations or Schedule
and covered for Physical Damage Coverage, we will pay for rental expenses for the rental of
a similar replacement auto and additional transportation expenses, incurred by you. This
payment applies in addition to the otherwise applicable amount of each coverage you have on
the covered auto. No deductible applies to this coverage. However:
(1) We will pay only for those expenses incurred by you that begin 24 hours after the
covered loss.
(2) We will cease paying for those expenses, regardless of the policy’s expiration date, at
the earlier of the following dates:
(a) The number of days reasonably required to repair or replace the covered auto. If
loss is caused by theft, this number of days is added to the number of days it takes
to locate and return the covered auto to you; or
(b) 45 days from the date this coverage begins.
(3) Our payment is limited to the lesser of the following amounts:
(a) Necessary and actual expenses incurred by you; or
(b) $1,500.
(4) This coverage does not apply while there are spare or reserve autos available to you for
Policy Number: SC V 013084 22 01
Page 6 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
your operations.
(5) If loss results from the total theft of a covered private passenger type auto (if CA0020
is attached to this policy), or a covered private passenger auto (if CA0001 is attached
to this policy), we will pay under this coverage only that amount of your covered rental
expenses or additional transportation expenses which are not already provided for under
the Physical Damage Coverage Extensions.
L. Extended Towing Coverage
1. Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A.
Coverage, 2. Towing, is deleted and replaced by the following:
2. Extended Towing
We will pay up to $750 per disablement for towing and labor costs you incur each time
your covered auto is disabled. However:
a. All labor must be performed at the place of disablement; and
b. If the covered auto is of the private passenger type, no deductible applies; and
c. If the covered auto is not of the private passenger type, our obligation to pay will be
reduced by a $250 deductible per disablement.
d. If the covered auto is not of the private passenger type and the disablement results
from a loss covered under Section III - Physical Damage Coverage, A. Coverage,
Paragraphs 1, a., b., or c., there is no separate deductible for the Extended Towing
Coverage.
For purposes of this coverage, disablement means a breakdown of the covered auto
including mechanical breakdown, engine failure, or tire blowout, where re- pairs cannot be
made roadside and a tow is required to remove the auto from the roadway and to seek
additional services and repair.
2. Form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, A.
Coverage, 2. Towing - Private Passenger Autos, is deleted and replaced by the following:
2. Extended Towing
We will pay up to $750 per disablement for towing and labor costs you incur each time
your covered auto is disabled. However:
a. All labor must be performed at the place of disablement; and
b. If the covered auto is of the private passenger type no deductible applies; and
c. If the covered auto is not of the private passenger type our obligation to pay will be
reduced by a $250 deductible per disablement.
d. If the covered auto is not of the private passenger type and the disablement
results from a loss covered under Section III - Physical Damage Coverage, A.
Coverage, Paragraphs 1, a., b., or c., there is no separate deductible for the
Extended Towing Coverage.
For purposes of this coverage, disablement means a breakdown of the covered auto
Policy Number: SC V 013084 22 01
Page 7 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
including mechanical breakdown, engine failure, or tire blowout, where repairs cannot
be made roadside and a tow is required to remove the auto from the roadway and
to seek additional services and repair.
M. Cancellation - 120 Days Notice
If we cancel this policy for any reason other than nonpayment of premium, we will mail or
deliver to the first Named Insured at the last mailing address known to us, written notice of
cancellation at least 120 days prior to the effective date of cancellation.
N. Supplementary Payments - Increased Limits
Section II - Liability Coverage, 2. Coverage Extensions, a. Supplementary Payments, items (2)
and (4) are deleted and replaced by the following:
(2) Up to $2,500 for the cost of bail bonds (including bonds for related traffic law violations)
required because of an accident we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the insured at our request, including substantiated loss
of earnings up to $500 a day, because of time off from work.
O. Duties in the Event of Accident, Claim, Suit or Loss - Amended
Form CA0001 (if attached to this policy) Section IV - Business Auto Conditions, A. Loss
Conditions, item 2. a.; and form CA0020 (if attached to this policy) Section V - Motor Carrier
Conditions, A. Loss Conditions, item 2. a.; is deleted and replaced by the following:
a. In the event of accident, claim, suit or loss, you must promptly notify us or our authorized
representative when it becomes known to:
(1) You, if you are an individual;
(2) Your partner or member, if you are a partnership or joint venture;
(3) Your member, if you are a limited liability company;
(4) Your executive officer if you are an organization other than a partnership, joint venture or
limited liability company; or
(5) Your authorized representative or insurance manager.
Knowledge of an accident, claim, suit or loss by other persons does not imply that the
persons listed above have such knowledge.
Notice should include:
(1) How, when and where the accident or loss occurred; and
(2) The insured’s name and address; and
(3) To the extent possible, the names and address of any injured persons and witnesses.
P. Unintentional Failure to Disclose Hazards
Form CA0001 (if attached to this policy), Section IV - Business Auto Conditions, B. General
Policy Number: SC V 013084 22 01
Page 8 of 10 CA7018 10-14
Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved.
Conditions, item 2.; and form CA0020 (if attached to this policy), Section V - Motor Carrier
Conditions, B. General Conditions, item 2.; the following is added:
However, if you unintentionally fail to disclose any hazards existing at the inception date of this
policy, we will not deny coverage under this Coverage Form because of such failure. This
provision does not affect our right to collect additional premium or exercise our right of
cancellation or non-renewal.
Q. Fellow Employee Coverage
Section II - Liability Coverage, B. Exclusions, 5. Fellow Employee, the following is added:
However, this exclusion does not apply if the bodily injury results from the use of a covered auto
you own or hire, and provided that any coverage under this provision only applies in excess over
any other collectible insurance.
R. Limited Mexico Coverage
WARNING
AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE
LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS
ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER.
IN SOME CASES THE COVERAGE PROVIDED HERE MAY NOT BE RECOGNIZED BY
THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT
THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO
COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING IN
MEXICO.
THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR
OUTSIDE OF 25 MILES FROM THE BORDER OF THE UNITED STATES OF AMERICA.
Form CA0001 (if attached to this policy), Section IV - Business Auto Conditions, B. General
Conditions, item 7.; and form CA0020 (if attached to this policy), Section V - Motor Carrier
Conditions, B. General Conditions, item 7.; the following is added:
The coverage territory is extended to include Mexico, but only:
a. For accidents or losses occurring within 25 miles of the United States border; and
b. For trips into Mexico of 10 days or less; and
c. If the covered auto is principally garaged and principally used in the United States; and
d. If the insured is a resident of the United States.
If a loss to a covered auto occurs in Mexico, we pay for such loss in the United States. If the
covered auto must be repaired in Mexico in order to be driven, we will not pay for more than the
actual cash value of such loss as determined by us at the nearest United States point where the
repairs can be made.
Any insurance provided under this provision will be excess over any other collectible insurance.
Policy Number: SC V 013084 22 01
Page 9 of 10 CA7018 07-17
Copyright © 2017 Allianz Global Risks US Insurance Company. All rights reserved.
S. Extended Glass Coverage
Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage,
item 3.a.; and form CA0020 (if attached to this policy), Section IV - Physical Damage
Coverage, A. Coverage, item 3.a.; is deleted and replaced by the following:
a. Glass breakage. If glass must be replaced, the deductible will be $100 or the deductible
shown in the Declarations, whichever is less. If glass can be repaired and is actually repaired
rather than replaced, the deductible will be waived. You have the option of having the glass
repaired rather than replaced.
T. Broadened Definition of Bodily Injury
Form CA0001 (if attached to this policy), Section V - Definitions, item C.; and Form CA0020 (if
attached to this policy), SECTION VI - DEFINITIONS, item C.; is deleted and replaced by the
following:
C. Bodily Injury means bodily injury, sickness or disease sustained by a person including
death or mental anguish resulting from any of these at any time. Mental anguish means any
type of mental or emotional illness or disease.
U. Customer Lease or Loan Physical Damage Coverage Extension
Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, C. Limit Of
Insurance; and form CA0020 (if attached to this policy), Section IV - Physical Damage
Coverage, C. Limits Of Insurance; item 4. is added as follows:
4. If your covered owned auto is:
(1) Shown in the Schedule and designated as covered for Physical Damage Coverage; and
(2) Shown in this policy as having a loss payee or additional-insured-lessor; and
(3) Incurs a covered total loss;
we will pay the greater of:
(a) The actual cash value, as determined by us, of the damaged or stolen property as of
the time of the total loss; or
(b) The outstanding indebtedness under the initial finance agreement for the covered
auto and its equipment.
As used here, outstanding indebtedness means the amount you owe on the finance
agreement at the time of total loss:
(i) Less any amounts representing taxes, overdue payments, penalties, interest, or charges
resulting from overdue payments, additional mileage, excess wear and tear, or lease
termination fees; and
(ii) Less any administrative costs or overhead fees assessed by the finance company who
has leased the covered auto to you; and
(iii) Less security deposits not returned by the lessor; and
(iv) Less costs for extended warranties, Credit Life Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease; and
Policy Number: SC V 013084 22 01
Page 10 of 10 CA7018 07-17
Copyright © 2017 Allianz Global Risks US Insurance Company. All rights reserved.
(v) Less carry-over balances from previous loans or leases.
V. Two or More Deductibles
1. Section III - Physical Damage Coverage, D. Deductible, of form CA0001 (if attached to this
policy), the following is added:
If another Allianz Global Risks US Insurance Company policy or coverage form that is not an
automobile policy or coverage form applies to the same accident or loss, the following
applies:
(1) If the deductible under this Business Auto Coverage Form is the lesser of (or least)
deductible, it will be waived.
(2) If the deductible under this Business Auto Coverage Form is not the lesser, (or least)
deductible, it will be reduced by the amount of the lesser (or least) deductible.
2. Section IV - Physical Damage Coverage, D. Deductible, of form CA0020 (if attached to this
policy), the following is added:
If another Allianz Global Risks US Insurance Company policy or coverage form that is not an
automobile policy or coverage form applies to the same accident or loss, the following
applies:
(1) If the deductible under this Business Auto Coverage Form is the lesser of (or least)
deductible, it will be waived.
(2) If the deductible under this Business Auto Coverage Form is not the lesser, (or least)
deductible, it will be reduced by the amount of the lesser (or least) deductible.
All other terms and conditions of the policy remain unchanged.
Policy Number: SC V 013084 22 01
CG 20 26 12 19
© Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: USC032778220
COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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):
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
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.
145977 03 19
Copyright © 2019 Allianz Global Risks US Insurance Company. All rights reserved. Page 1 of 1
Courtesy Notice of Cancellation for Other Than
Nonpayment of Premium to Designated Entities - 145977 03 19
Policy Amendment
Schedule
Name and Address of Person(s) or Organizations Number of Days Notice if other than 10 days:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
This policy is amended as follows:
A. If We cancel this policy prior to expiration for any reason other than non payment of premium or at Your request,
and we have been notified that You are required under a current contractual obligation to notify a certificate of
insurance holder or holders when this policy is canceled, then We will endeavor to mail or deliver a copy of such
written notice of cancellation to the certificate holder(s) shown in the Schedule above, as follows:
1. To the name and address corresponding to each certificate of insurance holder indicated in the Schedule
above; and
2. At least 10 days prior to the effective date of the cancellation, as shown in our notice to the first Named
Insured, or, if indicated, the longer number of days notice shown in the Schedule above.
B. Notwithstanding the foregoing, such notice of cancellation is provided on an informational basis and solely to
assist You in informing the certificate of insurance holder(s) in advance of pending cancellation in coverage to
assist you in meeting Your contractual notice requirements to such parties. Our failure to provide such advance
notification to the certificate of insurance holder(s) shown in the Schedule of this endorsement will not extend any
policy cancellation date, negate any cancellation of the policy, or grant, alter or extend any rights or obligations
under this policy and we shall have no liability for any failure to provide the notice(s) as provided herein.
All other terms and conditions of this policy remain unchanged.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT−CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule.
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule.
The additional premium for this endorsement shall be 2.00% of the California workers’ compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization
Job Description
Associated
Job
Premium
Blanket Waiver of Subrogation as required by written contract.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 12/04/2022
Insured CSG Consultants, Inc.
Policy No. SCW0239532201
Insurance Company National Surety
Corporation
Endorsement No.
Premium
Countersigned By
WC 04 03 06
(Ed. 04-84)
CSG Consultants Blackberry Farm Pole
Inspection – Year 3
Final Audit Report 2023-04-13
Created:2023-04-10
By:City of Cupertino (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAqveNkmSSlUf6rmU1u4vnuFHnikw4o_1b
"CSG Consultants Blackberry Farm Pole Inspection – Year 3" Hi
story
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2023-04-13 - 6:46:06 PM GMT- IP address: 64.165.34.3
Document e-signed by Christopher D. Jensen (christopherj@cupertino.org)
Signature Date: 2023-04-13 - 6:46:08 PM GMT - Time Source: server- IP address: 64.165.34.3
Document emailed to Chad Mosley (chadm@cupertino.org) for signature
2023-04-13 - 6:46:10 PM GMT
City of Cupertino (webmaster@cupertino.org) added alternate signer Jimmy Tan, P.E. (jimmyt@cupertino.org).
The original signer Chad Mosley (chadm@cupertino.org) can still sign.
2023-04-13 - 10:09:54 PM GMT- IP address: 174.85.76.31
Document emailed to Jimmy Tan, P.E. (jimmyt@cupertino.org) for signature
2023-04-13 - 10:09:54 PM GMT
Email viewed by Jimmy Tan, P.E. (jimmyt@cupertino.org)
2023-04-13 - 10:10:51 PM GMT- IP address: 104.47.74.126
Document e-signed by Jimmy Tan, P.E. (jimmyt@cupertino.org)
Signature Date: 2023-04-13 - 10:11:23 PM GMT - Time Source: server- IP address: 64.165.34.3
Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2023-04-13 - 10:11:24 PM GMT
Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2023-04-13 - 10:13:33 PM GMT- IP address: 104.28.124.96
Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2023-04-13 - 11:18:17 PM GMT - Time Source: server- IP address: 64.165.34.3
Agreement completed.
2023-04-13 - 11:18:17 PM GMT
Names and email addresses are entered into the Acrobat Sign service by Acrobat Sign users and are unverified unless otherwise noted.
