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Home My WebLink About25-030 Advanced Systems Group, LLC_ Amendment #1 dated 11-6-25 for Modernization of Broadcast TV & Community Hall Integration1 FIRST AMENDMENT TO AGREEMENT 25-030 BETWEEN THE CITY OF CUPERTINO AND ADVANCED SYSTEMS GROUP, LLC., FOR DESIGN & IMPLEMENTATION FOR MODERNIZATION OF BROADCAST TV & COMMUNITY HALL INTEGRATION This First Amendment to Agreement 25-030 is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and Advanced Systems group, LLC., a corporation (“Contractor”) whose address is 1226 Powell Street, Emeryville, CA 94608, and is made with reference to the following: RECITALS: A. On March 5, 2025, Agreement 25-030 (“Agreement”) was entered into by and between City and Contractor for Design & Implementation for Modernization of Broadcast TV & Community Hall Integration. B. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: COMPENSATION 1. Paragraph 4 of the Agreement is modified to read as follows: 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 $1,210,000.00 (“Contract Price”). 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 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. INSURANCE 2. Paragraph 12 of the Agreement is modified to read as follows: Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit D1, 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 2 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. Exhibit D of the Agreement is replaced with a new Exhibit D1 attached hereto. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. SIGNATURES CONTINUE ON THE FOLLOWING PAGE 3 IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CITY OF CUPERTINO By Title Date APPROVED AS TO FORM Senior Assistant City Attorney ATTEST: City Clerk Date ADVANCED SYSTEMS GROUP, LLC. By Title Date EXPENDITURE DISTRIBUTION ITEM AMOUNT Base Agreement $1,100,000 First Amendment $110,000 Total $1,210,000 CFO 11/05/2025 Teri Gerhardt CTO 11/06/2025 11/06/2025 Exh. D-Insurance Requirements for Professional Consultant Contracts 1 Version: May 2025 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) with coverage at least as broad as Insurance Services Office (ISO) Form CG 00 01, with limits no less than $2,000,000 per occurrence and $2,000,000 general aggregate. The policy shall include a per project or per location general aggregate endorsement as broad as CG 25 03 or CG 24 04. If a per project/location endorsement is not available, the limit of the general aggregate shall be doubled. 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 allow and be endorsed "primary and non-contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as the most recent edition of ISO Form CG 20 01. c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess liability insurance, provided each policy follows form of the underlying policy and 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. The City’s own insurance or self-insurance shall not be called upon. 2. Automobile Liability: Coverage shall be provided using ISO CA 00 01 covering any auto (including owned, hired, and non-owned autos) with limits no less than $1,000,000 each accident for bodily injury and property damage. Not required. Consultant shall be fully remote and not use automobiles to provide the service. In the event Consultant uses an automobile or automobiles in the operation of its business to provide services under this Agreement, the Consultant shall, prior to such use, provide the City with evidence of Business Automobile Liability insurance coverage in the amount required under this Section 2 for owned, non-owned and hired autos (any auto-Symbol 1), or if Consultant does not own autos (hired autos-Symbol 8 and non-owned autos-Symbol 9). Evidence shall be provided with a Certificate of Insurance, along with an additional insured endorsement in favor of the City, primary and non- contributory coverage and endorsement, and waiver of subrogation coverage and endorsement under the policy prior to the use of any automobile. Ξ Consultant has provided written confirmation that it does not own any autos. Consultant shall provide coverage for hired autos-Symbol 8 and non-owned autos-Symbol 9. Primary and Non-Contributory coverage and Waiver of Subrogation coverage is waived under the Automobile Liability hired and non-owned only coverage. In the event Consultant uses an owned automobile or automobiles in the operation of its business to provide services under this Agreement, the Consultant shall, prior to such use, provide the City with evidence of Business Automobile Liability insurance coverage in the amount required under this Section 2 for owned, non-owned and hired autos (any auto-Symbol 1). EXHIBIT D1 Insurance Requirements Professional Consultant Contracts Exh. D-Insurance Requirements for Professional Consultant Contracts 2 Version: May 2025 In lieu of Business Automobile Liability, Consultant shall maintain throughout the term of this Agreement and provide the City with evidence (including the policy Declarations Page) of personal automobile insurance coverage in accordance with the laws of the State of California. As available under the policy, evidence shall be provided with the Certificate of Insurance, along with an additional insured endorsement in favor of the City, primary and non-contributory coverage and endorsement, and waiver of subrogation coverage and endorsement. City approval of coverage is required prior to commencement of services. 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 each accident/ disease. Not required. Consultant has provided written verification of no employees. 4. Professional Liability for professional acts, errors and omissions, if applicable and 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 basis 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. OTHER INSURANCE PROVISIONS The aforementioned insurance policies shall contain, be endorsed and have all the following conditions and provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, and volunteers (“Additional Insureds”) are to be covered and endorsed 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 if not available, through the addition of both CG 20 10 and CG 20 37 forms, if later editions are used). Primary and Non-Contributory Coverage Except Workers Compensation, coverage afforded to City/Additional Insureds shall allow and be endorsed 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. If a carrier will not provide the required notice of cancellation or policy modification, the Consultant shall provide written notice to the City of a cancellation or policy modification no later than 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 General Liability, Automobile Liability and Workers’ Compensation policies shall allow and be endorsed with a waiver of subrogation in favor of City, its employees, agents and volunteers. This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Exh. D-Insurance Requirements for Professional Consultant Contracts 3 Version: May 2025 Deductibles and Self-Insured Retentions Any deductible or self-insured retention must be declared to and approved by the City (Insert on the Certificate of Insurance, if zero, insert “$0”). 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 Insurance shall be placed with insurers admitted in the State of California and with an AM Best rating of A- VII or higher. Verification of Coverage Consultant must furnish acceptable insurance certificates and amendatory endorsements (or copies of the policies effecting the coverage required by this Contract), including 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 indemnification, defense, and 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY X Errors and Omissions 3URIHVVLRQDO/LDELOLW\PHPK2640504-006 01/01/2025 01/01/2026 (DFK&ODLP $JJUHJDWH $,000,000 The City of Cupertino, It's City Council, Officers, Officials, Employees, Agents, Servants, and Volunteers are included as additional insured as required by written contract with respect to General Liability and Auto Liability. Coverage is Primary and Non-Contributory. Waiver of Subrogation applies in favor of the additional insureds with respect to General Liability, Auto Liability and Workers Compensation. Per Project Aggregate applies. Notice of Cancellation applies with respect to General Liability, Auto Liability and Workers CompensationGD\VLQDGYDQFHRUGD\VLQDGYDQFHLIGXHWRQRQSD\PHQWRISUHPLXP. X 1R'HGXFWLEOH6,5 'HGXFWLEOH 121( 5HWHQWLRQ 12'('8&7,%/( $2,000,000 ACORD® I ~ -------, I X ~ □ [X] ~ ~ Fl [X] □ ~ ~ ~ X X X ~ I I X I I I □ I VCU 411 06 18 Contains copyrighted material of Insurance Services Office, Inc., with its permission. Copyright 2018, Page 1 of 1 POLICY NUMBER: UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY COVERAGE FORM The following is added to Paragraph 5. Other Insurance under SECTION IV – COMMERCIAL UMBRELLA LIABILITY CONDITIONS: Primary And Noncontributory Regardless of the provisions of Paragraph a. above, this insurance is primary to, and will not seek contribution from, any “underlying insurance” available to an additional insured if: (1)Such additional insured is a Named Insured under that other insurance; and (2)You have agreed in writing in a contract, agreement or permit that this insurance would be primary and would not seek contribution from any other insurance available to such additional insured. Intact Insurance Group USA LLC E-INSURED Endorsement Effective Countersigned by Policy No. Premium $Insured Insurance Company Endorsement No. All other terms and conditions of this policy remain unchanged. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. TO DESIGNATED PERSONS OR ORGANIZATIONS NOTICE OF CANCELLATION POLICY NUMBER: ENDORSEMENT WC 99 06 R3 (00) - EMPLOYERS LIABILITY POLICY AND WORKERS COMPENSATION Notice Of Cancellation To Designated Persons Or Organizations Name and Address of Designated Persons or Organizations: Number of Days Notice The following is added to PART SIX – CONDITIONS : SCHEDULE If we cancel this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organiza- tion before the cancellation is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation. ONE TOWER SQUARE UB-2W164878-25-I3-G HARTFORD CT 06183 001 10300 TORRE AVE CUPERTINO CA 95014 THE CITY OF CUPERTINO 30 Page ofDATE OF ISSUE: ST ASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. 01-30-25 11 ~ TRAVELERSJ , VIL 229 06 12 Copyright 2012, Page 1 of 1 Policy Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Notice of Cancellation to Designated Certificate Holder A. If we cancel this policy for any reason other than nonpayment of premium, we will endeavor to provide notice of such cancellation to the certificate holder(s) at the address(s) shown in the schedule below when notice of cancellation is sent to the first Named Insured. In no event will the timing of notice to a certificate holder exceed the timing of notice to the first Named Insured. B. Our failure to provide notice of cancellation to a certificate holder scheduled below will not amend or extend the effective policy cancellation date or negate policy cancellation. Notice of cancellation is provided solely as a courtesy for the convenience of the first Named Insured and does not constitute a prerequisite to effective policy cancellation or confer any rights whatsoever on the certificate holder(s) scheduled below. SCHEDULE Name of Certificate Holder and Address Intact Insurance Group USA LLC 711-01-81-06-0002 BLANKET PER SCHEDULE ON FILE WITH NAMED INSURED THE CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO, CA 95014-3202 E-IN URED ! "#$#"#"%&%#$'(& ! )*+,-.*/010-23/0+443/05*/65789: %;<= >? $$#($@A#B### #@%$%# CD3+0*EF-+0G0*HGFE3430+3*+,-.*/0I-F23E0E,*E0-HD04FJJFK3*L MN MMCO MNM C P C1Q CP MC1MCO MNM C #"$( ;R=?SSTUT>V;WVXYZ=S%=ZX>V[X\ZZ<;VT];UT>V[X\ >^;UT>VVS$=X^ZT_UT>V?>R_W=U=S_=Z;UT>VX *4F-G.H3F*-0`,3-0EHF/FGIJ0H0HD3+1/D0E,J0534*FH+DFK*.aF205K3JJa0+DFK*3*HD0P0/J.-.H3F*+6 bcdefgchijgklghm nn opqrsotuvrwxqyoszu n{|{{ouyyq}~q rwxqyoszur}€ {n‚ƒ|„{„ …nnƒ{nƒ†nƒ{‡ƒ{{{„ ˆ1 P CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. All Projects E-INSURED Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 A.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I – Coverage A, and for all medical expenses caused by acci- dents under Section I – Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1.A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2.The Designated Construction Project Gen- eral Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "prod- ucts-completed operations hazard", and for medical expenses under Coverage C re- gardless of the number of: a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits". 3.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4.The limits shown in the Declarations for Each Occurrence, Damage to Premises Rented to You and Medical Expense contin- ue to apply. However, instead of being sub- ject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I – Coverage A, and for all medical expenses caused by accidents un- der Section I – Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2.Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C.When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D.If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E.The provisions of Section III – Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 9 Copyright 2017, Policy Number: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM GENERAL LIABILITY ENDORSEMENT – TECHNOLOGY COMPANIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement extends certain coverages. The following listing and the headers in this endorsement are only for convenience. Provisions in this endorsement might be modified by other endorsements. Read the entire policy carefully to determine rights, duties and what is and is not covered. Section I – Coverages 1.Expected or Intended Injury (Property Damage) 2.Non-Owned Aircraft and Watercraft Under 55 Feet 3.Broadened Property Damage – Rented Premises, Borrowed Equipment Use of Elevators 4.Personal and Advertising Injury Exclusions a.Insureds in Media and Internet Type Businesses b.Electronic Chatrooms or 5.Medical Payments – Increased Limits and Time Period 6.Product Recall Expense Coverage 7.Supplementary Payments – Cost of Bail Bonds and Loss of Earnings B.Section II – Who is an Insured 1.Broadened Named Insured 2.Additional Insured – Broad Form Vendor 3.Additional Insured – Written Contract, Agreement, Permit or Authorization 4.Incidental Malpractice by Employed Physicians, Nurses, EMTs and Paramedics 5.User of Covered Watercraft 6.Newly Acquired or Formed Organizations C.Section III – Limits of Insurance – Aggregate Limit Per Location Section IV – Commercial General Liability Conditions 1.Duties in Event of Occurrence, Offense, Claim or Suit 2.Waiver of Subrogation When Required by Written Contract or Agreement E.Section V – Definitions 1.Bodily Injury – Includes Mental Anguish 2.Coverage Territory – Worldwide 3.Mobile Equipment – Self-Propelled Snow Removal, Road Maintenance and Street Gross Vehicle Weight A. Section I – Coverages 1. Expected or Intended Injury (Property Damage) The following is added to Exclusion 2.a. Expected Or Intended Injury of Section I – Coverages – Coverage A – Bodily Injury and Property Damage Liability : This exclusion does not apply to “property damage” resulting from the use of reasonable force to protect persons or property. 2. Non-Owned Aircraft and Watercraft Under 55 Feet a.The following is added to Exclusion 2.g. Aircraft, Auto or Watercraft of Section I – Coverages – Coverage A – Bodily Injury and Property Damage Liability: This exclusion does not apply to an aircraft that is: (a)Hired, chartered or loaned with a paid crew; and (b)Not owned by any insured. b.The following replaces Exclusion 2.g.(2)(a) of Section I – Coverages – Coverage A – Bodily Injury and Property Damage Liability: (a)Less than 55 feet long; and Intact Insurance Group USA LLC E-INSURED VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 9 Copyright 2017, c.The following is added to Paragraph b.(1) in Paragraph 4. Other Insurance of Section IV – Commercial General Liability Conditions : This insurance is excess over any of the other valid and collectible insurance available to the insured that provides coverage for aircraft or watercraft not owned by any insured, whether such insurance is primary, excess, contingent or on any other basis. 3. Broadened Property Damage – Rented Premises, Borrowed Equipment and Use of Elevators a.The following is added to Exclusion 2.j. Damage To Property of Section I – Coverages – Coverage A – Bodily Injury and Property Damage Liability : Paragraph (1) of this exclusion does not apply to “property damage” to real property you rent or temporarily occupy with permission of the owner. Paragraph (4) of this exclusion does not apply to “property damage” to equipment you borrow while at a job site if the equipment is not being used by anyone to perform work or operations at the time of loss. Paragraphs (3), (4) and (6) of this exclusion do not apply to “property damage” arising out of the use of elevators at premises you own, rent, lease or occupy. b.The following replaces Paragraph 6. of Section III – Limits Of Insurance: 6.Subject to Paragraph 5. above, the Damage to Premises Rented to You Limit shown in the Declarations is the most we will pay under Coverage A for damages because of “property damage” to any one premises while rented to you or occupied by you with permission of the owner. If a Damage to Premises Rented to You Limit is not shown in the Declarations, that Limit will be $500,000. c.The following is added to Paragraph b.(1) of Paragraph 4. Other Insurance of Section IV – Commercial General Liability Conditions: This insurance is excess over any of the other valid and collectible insurance available to the insured that provides coverage for real property you rent or temporarily occupy with the permission of the owner, borrowed equipment or use of elevators, whether such insurance is primary, excess, contingent or on any other basis. 4. Personal and Advertising Injury Exclusions a. Insureds in Media and Internet Type Businesses The following replaces Exclusion 2.j. Insureds In Media And Internet Type Businesses of Section I – Coverages – Coverage B – Personal and Advertising Injury Liability: “Personal and advertising injury” committed by an insured whose business is: (1)Advertising, broadcasting, publishing or telecasting; or (2)Designing or determining content of web sites for others. However, this exclusion does not apply to Paragraphs 14.a., b. and c. of "personal and advertising injury" under the Definitions section. For the purposes of this exclusion, the placing of frames, borders or links, or advertising for you, is not by itself considered the business of advertising, broadcasting, publishing or telecasting. b. Electronic Chatrooms or Bulletin Boards The following replaces Exclusion 2.k. Electronic Chatrooms Or Bulletin Boards of Section I – Coverages – Coverage B – Personal and Advertising Injury Liability: "Personal and advertising injury" arising out of an electronic chatroom or bulletin board the insured hosts, owns or maintains for others. 5. Medical Payments – Increased Limits and Time Period The following provisions are modified only if Coverage C is not otherwise excluded by the provisions of this Coverage Part or any endorsement. a.The following replaces Paragraph a.(3)(b) in Paragraph 1. Insuring Agreement of Section I – Coverage C – Medical Payments: (b)The expenses are incurred and reported to us within three years of the date of the accident; and Intact Insurance Group USA LLC POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 9 Copyright 2017, b.The following is added to Paragraph 7. of Section III – Limits Of Insurance: The Medical Expenses Limit for Coverage C is the greater of $15,000 per person or the amount shown in the Declarations. 6. Product Recall Expense Coverage a.The following is added to Section I – Coverages: Product Recall Expense Schedule Product Recall Aggregate Limit $ 50,000 Each Product Recall Limit $ 25,000 Each Product Recall Deductible $1,000 The limits and deductible in this Schedule apply to Product Recall Expense Coverage unless other amounts are shown in the Declarations. PRODUCT RECALL EXPENSE COVERAGE We will pay “product recall expense” incurred by you or on your behalf for a “covered recall” to which this insurance applies. This insurance applies to “product recall expense” for a “covered recall” that takes place in the “coverage territory” and during the policy period. The amount we will pay for “product recall expense” is limited as described in Section III – Limits Of Insurance. We will only pay the amount of “product recall expense” in excess of the Each Product Recall Deductible shown in the Schedule above. You must pay the Each Product Recall Deductible for each “covered recall” that is initiated. b.The following is added to Section III – Limits Of Insurance: The Product Recall Aggregate Limit shown in the Schedule above is the most we will pay for the sum of all “product recall expense” incurred for all “covered recalls” initiated during the policy period. Subject to the Product Recall Aggregate Limit, the Each Product Recall Limit shown in the Schedule above is the most we will pay for all “product recall expenses” arising out of any one “covered recall” for the same defect or deficiency. c.The following is added Section IV – Commercial General Liability Conditions: Duties In The Event Of “Covered Recall” 1.You must report a “covered recall” to us as soon as practicable and no later than 30 days after you discover or are made aware of such recall. 2.No insured will, except at that insured’s own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3.You must see to it that the following are done as soon as practicable after an actual or anticipated “covered recall” that may result in “product recall expense”: (a)Give us notice of any discovery or notification that “your product” must be withdrawn or recalled, including a description of “your product” and the reason for the withdrawal or recall; (b)Cease any further release, shipment, consignment or any other method of distribution of such product, as well as any similar products, until it has been determined that all such products are free from defects that could result in “product recall expense”; (c)As often as may be reasonably required, permit us to: (1)Inspect “your product” and take damaged and undamaged samples of “your products” for inspection, testing and analysis; and (2)Examine and make copies from your books and records; (d)Within 60 days of our request and providing you the necessary forms, send us a signed, sworn proof of loss containing the information we request to settle the claim; and Intact Insurance Group USA LLC POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 9 Copyright 2017, (e)Permit us to examine any insured under oath, while not in the presence of any other insured, at such times as may reasonably be required, about any matter relating to this insurance or your claim, including an insured's books and records. An insured’s answers to the examination must be signed. d.The following are added to Section V – Definitions: “Covered recall” means a recall of “your product” made necessary because the insured or a government entity has determined that a known or suspected defect, deficiency, inadequacy or dangerous condition in “your product” has resulted in, or will result in, “bodily injury” or “property damage”. “Product recall expense”: a.Means the following necessary and reasonable extra expenses incurred by you or on your behalf exclusively for the purpose of recalling “your product”: (1)Expenses for communications, including broadcast announcements or printed “advertisements” and associated stationery, envelopes and postage; (2)Expenses for shipping the recalled products from any purchaser, distributor or user to the place or places designated by you; (3)Expenses for overtime paid to your regular non-salaried “employees”; (4)Expenses for hiring “temporary workers”; (5)Expenses incurred by “employees”, including transportation and accommodations; (6)Expenses to rent additional warehouse or storage space; or (7)Expenses for proper disposal of “your product” if the disposal is necessary to avoid “bodily injury” or “property damage” and is other than regularly used to discard, trash or dispose of “your product”. b.Does not include the following: (1)Damages, fines or penalties; (2)Defense expenses; (3)The cost of regaining your market share, goodwill, revenue or profit; or (4)Any expenses resulting from: (a)Failure of any product to accomplish its intended purpose; (b)Breach of warranties of fitness, quality, durability or performance; (c)Loss of customer approval, or any cost incurred to regain customer approval; (d)Redistribution or replacement of “your product” that was recalled with like products or substitutes; (e)The insured’s caprice or whim; (f)A condition any insured knew, or had reason to know, of at the inception of this insurance that was likely to cause loss; or (g)Recall of “your products” that have no known or suspected defect solely because a known or suspected defect in another of “your products” has been found. 7. Supplementary Payments – Cost of Bail Bonds and Loss of Earnings The following replaces Paragraphs 1.b. and 1.d. of Supplementary Payments – Coverages A and B in Section I – Coverages: b.Up to $2,500 for 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 actual loss of earnings up to $250 a day because of time off from work. Intact Insurance Group USA LLC POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 9 Copyright 2017, B. Section II – Who is an Insured 1. Broadened Named Insured Section II – Who Is An Insured is amended to include as a Named Insured any legally incorporated entity in which you maintain ownership of more than 50 percent of the voting stock on the effective date of this endorsement, but only if there is no other similar insurance available to that organization. This insurance does not apply to any organization that is an insured under another policy or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. 2. Additional Insured – Broad Form Vendor a. Section II – Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as “vendor”) with whom you have agreed in a written contract or agreement to provide insurance, but only with respect to “bodily injury” or “property damage” arising out of “your products” that are distributed or sold in the regular course of the vendor’s business. But none of these vendors are an additional insured: (1)If the “products-completed operations hazard” is excluded under the Coverage Part or by endorsement; (2)If the vendor is a person or organization from whom you have acquired the products, or any ingredient, part or container entering into, accompanying or containing those products; (3)For “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 unless that the vendor would have otherwise been liable for such “bodily injury” or “property damage” in the absence of that contract or agreement; or (4)For “bodily injury” or “property damage” caused by or arising out of: (a)Any express warranty not authorized by you; (b)Any physical or chemical change in the product made intentionally by the vendor; (c)Repackaging, except when 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; (d)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; (e)Operations to demonstrate, install, service or repair, except those operations performed at the vendor’s premises in connection with the sale of the product; (f)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 (g)The sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf, unless such act or omission is: (i)In the course of repackaging “your products” in the original container after unpacking solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer; (ii)A demonstration, installation, servicing or repair operation of “your products” performed at the vendor’s premises in connection with the sale of the product; or (iii)An inspection, adjustment, test or servicing of “your products” 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. b.The insurance afforded to such vendor under Paragraph a. above: (1)Applies only to the extent permitted by law; and (2)Will not be broader than that which you are required by the contract or agreement to provide to such vendor. Intact Insurance Group USA LLC POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 9 Copyright 2017, c.The following is added to Section III – Limits Of Insurance: The most we will pay on behalf of a vendor that qualifies as an additional insured is the amount of insurance: a.Required by the contract or agreement; or b.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This provision does not increase the applicable Limits of Insurance shown in the Declarations. 3. Additional Insured – Written Contract, Agreement, Permit or Authorization a. Section II – Who Is An Insured is amended to include as an additional insured any person or organization with whom you have agreed in a written contract, agreement, permit or authorization to provide insurance but only with respect to liability for injury or damage caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf for: (1)“Bodily injury”, “property damage” or “personal and advertising injury” in the performance of your ongoing operations, and only until your operations are completed, for such person or organization at the location designated in the contract, agreement, permit or authorization; (2)“Bodily injury”, “property damage” or “personal and advertising injury” in the maintenance, operation or use of equipment leased to you by such person or organization; or (3)“Bodily injury”, “property damage” or “personal and advertising injury” in connection with premises you own, rent, lease or occupy. b.The insurance afforded to an additional insured under Paragraph a. above does not apply: (1)Unless: (a)The contract or agreement is executed, or the permit or authorization is issued, before the “bodily injury”, “property damage” or “personal and advertising injury” occurs; and (b)The contract, agreement, permit or authorization is in effect or becomes effective during the policy period. (2)To any: (a)Person or organization included as an insured under any other provision of this policy, including this or any other endorsement; (b)Lessor of equipment after the equipment lease terminates or expires; (c)Owner or other interests from whom land has been leased; (d)Manager or lessor of premises if: (i)The “occurrence” takes place after you cease to be a tenant in that premises; or (ii)The “bodily injury”, “property damage” or “personal and advertising injury” arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. ((ee))Person or organization if the “bodily injury”, “property damage” or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (i)The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (ii)Supervisory, inspection, architectural or engineering activities. This exclusion applies 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 and advertising injury”, involved the rendering of or the failure to render any professional architectural, engineering or surveying services; or Intact Insurance Group USA LLC POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 9 Copyright 2017, (f)"Bodily injury" or "property damage" occurring after: (i)All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (ii)That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. c.The insurance afforded to an additional insured under Paragraph a. above: (1)Applies only to the extent permitted by law; and (2)Will not be broader than that which you are required by the contract, agreement, permit or authorization to provide to such additional insured. d.With respect to the insurance afforded to an additional insured under Paragraph a. above: (1)The following is added to Paragraph 4. Other Insurance of Section IV – Commercial General Liability Conditions: Regardless of the provisions of Paragraphs a. and b. above, this insurance is primary to, and will not seek contribution from, any other insurance available to an additional insured if: (1)Such additional insured is a Named Insured under that other insurance; and (2)You have agreed in the contract, agreement, permit or authorization that this insurance would be primary and would not seek contribution from any other insurance available to such additional insured. (2)The following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: a.Required by the contract, agreement, permit or authorization; or b.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This provision does not increase the applicable Limits of Insurance shown in the Declarations. 4. Incidental Malpractice by Employed Physicians, Nurses, EMTs and Paramedics a.The following is added to Paragraph 2.a.(1)(d) of Section II – Who Is An Insured: But an “employee” or “volunteer worker” employed or volunteering as a physician, dentist, nurse, emergency medical technician or paramedic is an insured if you are not engaged in the business or occupation of providing professional health care services. b.The following is added to Paragraph b.(1) in Paragraph 4. Other Insurance of Section IV – Commercial General Liability Conditions : This insurance is excess over any of the other valid and collectible insurance available to the insured for coverage for insured “employee” or volunteer worker who is a physician, dentist, nurse, emergency medical technician or paramedic, whether such insurance is primary, excess, contingent or on any other basis. 5. User of Covered Watercraft a. Section II – Who Is An Insured is amended to include as an additional insured any person or organization who uses, or is responsible for the use of, a watercraft covered by this policy if the use is with your express or implied consent. But no such person or organization is an insured with respect to: a.“Bodily injury” to that person’s or organization’s “employee”; or b.“Property damage” to property: (1)Owned, occupied or used by; or (2)In the care, custody or control of, rented to or over which physical control is being exercised for any purpose by; that person or organization. Intact Insurance Group USA LLC POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 9 Copyright 2017, b.The following is added to Paragraph b.(1) in Paragraph 4. Other Insurance of Section IV – Commercial General Liability Conditions : This insurance is excess over any of the other valid and collectible insurance available to the insured for use of, or responsibility for use of, a watercraft covered by this policy, whether such insurance is primary, excess, contingent or on any other basis. 6. Newly Acquired or Formed Organizations The following replaces Paragraph 3.a. of Section II – Who Is An Insured: a.Coverage under this provision is afforded only until the end of the policy period; C. Section III – Limits of Insurance – Aggregate Limit Per Location The following is added to Paragraph 2. of Section III – Limits Of Insurance: The General Aggregate Limit applies separately to each “location” of yours. As used in this provision, “location” means premises you own, rent or lease involving the same or connecting lots, or whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. D. Section IV – Commercial General Liability Conditions 1. Duties in the Event of Occurrence, Offense, Claim or Suit The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV – Commercial General Liability Conditions: The requirements that you must notify us of an “occurrence”, offense, claim or “suit”, or send us documents concerning a claim or “suit”, apply only if the “occurrence”, offense, claim or “suit” is known to: (1)You, if you are an individual; (2)A partner, if you are a partnership; (3)An “executive officer” or insurance or risk manager, if you are a corporation; or (4)A manager, if you are a limited liability company. The requirement that you must notify us as soon as practicable of an “occurrence” or an offense that may result in a claim does not apply if you report the “occurrence” or offense to your workers’ compensation insurer and that “occurrence” or offense later develops into a liability claim for which coverage is provided by this policy. But as soon as you become aware that an “occurrence” or offense is a liability claim rather than a workers’ compensation claim, you must comply with all parts of Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV – Commercial General Liability Conditions. 2. Waiver of Subrogation When Required by Written Contract or Agreement The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of Section IV – Commercial General Liability Conditions: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or “your work” included within the “products-completed operations hazard” if the operations or work is done under a written contract or agreement with that person or organization, but only if the contract or agreement is executed before the “bodily injury” or “property damage” occurs and requires you to waive your rights of recovery. E. Section V – Definitions 1. Bodily Injury – Includes Mental Anguish The following is added to Paragraph 3. of Section V – Definitions: “Bodily injury” includes mental anguish resulting from bodily injury, sickness, or disease sustained by a person at any time. 2. Coverage Territory – Worldwide The following replaces Paragraph 4. of Section V – Definitions: 4.“Coverage territory” means anywhere other than a country or jurisdiction that is subject to trade or other economic sanction or embargo by the United States of America. But the insured’s Intact Insurance Group USA LLC POLICY NUMBER: VCG 207 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 9 Copyright 2017, responsibility to pay damages must be determined in a settlement we agree to or in a “suit” on the merits brought within the United States of America (including its territories and possessions), Puerto Rico or Canada. 3. Mobile Equipment – Self-Propelled Snow Removal, Road Maintenance and Street Cleaning Equipment Less than 1,000 Pounds Gross Vehicle Weight The following is added after Paragraph 12.f.(1) of Section V – Definitions: But a self-propelled vehicle of less than 1,000 pounds gross vehicle weight that is maintained primarily for purposes other than transportation of persons or cargo with permanently attached equipment for snow removal, road maintenance (other than construction or resurfacing) or street cleaning will be considered “mobile equipment” and not an “auto”. Intact Insurance Group USA LLC POLICY NUMBER: Policy Number: COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OB CA 200 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright 2018, Page 1 of 1 ADDITIONAL INSURED – AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Paragraph A.1. Who is an Insured of Section II – Covered Autos Liability Coverage is amended to include as an additional “insured” any person or organization with whom you have agreed in a written contract, agreement, permit or authorization to provide insurance such as is afforded under this Coverage Form but only with respect to liability for “bodily injury” or “property damage” caused in whole or in part by your maintenance, operation or use of a covered “auto”. But this insurance does not apply: 1.Unless the written contract or agreement has been executed or the permit or authorization has been issued prior to the “accident” that caused the “bodily injury” or “property damage”; 2.To any person or organization included as an “insured” under any other provisions of this policy, including any other endorsement; 3.To the independent acts or omissions of such person or organization; or 4.To any lessor of “autos” when their contract or agreement with you for such leased “auto” ends or the lessor or its agent takes possession of the “auto”. Intact Insurance Group USA LLC E-INSURED POLICY NUMBER: UB-2W164878-25-I3-G 1-1-2025 ~ TRAVELERSJ , ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) -001 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA (BLANKET WAIVER) 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 . The additional premium for this endorsement shall be 2. 00 % of the California workers' compensation pre mium. Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Schedule Job Description 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 Insured Insurance Company DATE OF ISSUE: Policy No. Endorsement No. Premium Countersigned by ____________ _ ST ASSIGN: Page 1 of 1 !""# $%&'()*++,-.+/$*+*/01234456 7 444567 45896:;6 6<=56:;86>5884 7? 567@ >5895567?75@6A?647@B @A6A9695@ 43<A 4>867695?@A@6 >6CA 55876564<5444?458 84 7658463596346585 44567 447 4458A964 5D 63975469568=4A E6>F "%G8 64456 844567 467@9975658H5593554?@ 7>I4 % 6<9644565844567 4 J 4?@6556<3558 64456 844567 4 >7765??6458585>88@6 J 4?@586556<3556964 6 844567 4 K%L58955658 6445658 44567 4586776><44456 &'()*+++,M)N)(/O+*/01*'P 6<9644565844567 4 J 4?@6556<3558365> >779@6?8765844567 458 36 56 F "%QJ 4?@586556<35I6 %R7?7 458997?77356 I >887 G846358776558997?7 7356 !"#$%&' ' ())*+,-./( /0,1*23(+1*)*2/024*1/0*5(-,675-*1*+*3,/+*8.--67 9,:*+(8/+218*+(8+,40/1(8+*(:*+6 4,21/(/0*+1/(.1;9,:*+(81.<+(4/,(2= >? @ A BA@ C @@ @ B?DDE ' F">G%F%&H%&FI%J&# $" !%F">H%&FI%J&# #>&F&& %&H%&FI%J&# KB? CBB C @@LMB? @ A BB?C B? J ACCDM D A@@LMB? @ A B >? @ A B? B?CDMB B? CB @BB?CDM D B? @B @B@ LDE 2NOPQ,RSTUPQV *RQWUSPOPRX*YYPZX[\P3NXPV 10*3.-* 2NOP;S=(Y5PUSWR;S=(U(U]NR[^NX[WR;S=V AB _ @BACDBB??@D B?E LEDDL?E B?GD B >?/UNRSYPU(Y+[]`XS(Y+PZW\PUa]N[RSX (X`PUS/W.S @B @ BCCDMBB? C bc dB bc?E B??@D LB DMBB?eB BB?BL B E@C BB?f@ Bf B?fDf @ B BEB? B?BC dB gghijklmnopqnqinrsturvwwx xyqqz{qsumjkkrp|jnjor|rnp}kjmnx gghijklmnopqnkp nri~qs€n~ hh ‚ƒ„…†‡ plrxmp~q{x}ˆrspmnq h„hhpqssrj‰r x}ˆrspmnq€xjŠgh ‚ƒ„†h† h y„hy†h†g ju‰jnxruk~kpr|kosq}ˆ€wwx ‡ ƒh ƒ‹ ƒh…ƒhhh† %Œ !"&%G ! "##$$%&'?@A&BC& (/01,23*DEFG< HI J K3,-4)5(1-464)*6(5,8,4-,)-91+).4/1(;,5459)541*348(77(>,)2 :::L KM LNO HJ J K348(77(>,)2,-+5545*(+1+21+/3S<TUAVWXYV?WZA(8H AWAV?[BW\]T]BWX9)541"^ H 42+1574--(8*34/1(;,-,()-(8+1+21+/3? +Q(;4<+)0,+Q,7,*0(;41+249)541*3,-(;41+24O(16,- /1,6+10*(<+)5>,77)(*-44_.()*1,Q9*,()81(6<+)0(*341,)-91+).4+;+,7+Q74*(+)0/41-()(1(12+),`+*,() -3(>),)*34 L LRK K :aR R : NLbLK:aR -3(>)+Q(;4,8 c&d:9.3/41-()(1(12+),`+*,(),-++645)-91459)541*3+*(*341,)-91+).4e+)5 c#d(93+;4+21445,)>1,*,)2,)+.()*1+.*<+214464)*(1/416,**3+**3,-,)-91+).4>(975Q4/1,6+10+)5 >(975)(*-44_.()*1,Q9*,()81(6+)0(*341,)-91+).4+;+,7+Q74*(-9.3/41-()(1(12+),`+*,()= )*+.*)-91+).4N1(9/ :L fgghighjghikhiiil mnopqmrstpuvowmqxsgiyiimswwoz{o puvowmqxspz|}ig~ : R VCU 411 06 18 Contains copyrighted material of Insurance Services Office, Inc., with its permission. Copyright 2018, Page 1 of 1 POLICY NUMBER: UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY COVERAGE FORM The following is added to Paragraph 5. Other Insurance under SECTION IV – COMMERCIAL UMBRELLA LIABILITY CONDITIONS: Primary And Noncontributory Regardless of the provisions of Paragraph a. above, this insurance is primary to, and will not seek contribution from, any “underlying insurance” available to an additional insured if: (1)Such additional insured is a Named Insured under that other insurance; and (2)You have agreed in writing in a contract, agreement or permit that this insurance would be primary and would not seek contribution from any other insurance available to such additional insured. Intact Insurance Group USA LLC E-INSURED Design & Implementation for Modernization of Broadcast TV & Community Hall Integration Final Audit Report 2025-03-05 Created:2025-02-25 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID: CBJCHBCAABAAu-6ctecx-EEQG1xA6m9GS7Hp5XXa26-2 "Design & Implementation for Modernization of Broadcast TV & Community Hall Integration" History Document created by Webmaster Admin (webmaster@cupertino.org) 2025-02-25 - 0:57:19 AM GMT- IP address: 35.229.54.2 Document emailed to aprild@cupertino.org for approval 2025-02-25 - 1:02:44 AM GMT Email viewed by aprild@cupertino.org 2025-02-25 - 1:03:16 AM GMT- IP address: 3.232.50.116 Signer aprild@cupertino.org entered name at signing as April DaRosa 2025-02-25 - 1:03:43 AM GMT- IP address: 99.61.166.82 Document approved by April DaRosa (aprild@cupertino.org) Approval Date: 2025-02-25 - 1:03:45 AM GMT - Time Source: server- IP address: 99.61.166.82 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2025-02-25 - 1:03:47 AM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2025-02-25 - 1:04:11 AM GMT- IP address: 52.202.236.132 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2025-02-25 - 2:19:34 AM GMT - Time Source: server- IP address: 71.202.76.156 Document emailed to Dave Van Hoy (dvh@asgllc.com) for signature 2025-02-25 - 2:19:37 AM GMT Email viewed by Dave Van Hoy (dvh@asgllc.com) 2025-02-25 - 7:19:18 AM GMT- IP address: 24.6.66.89 6a 6a 6a I Poweredby · Adobe cu,m,No Acrobat Sign Email viewed by Dave Van Hoy (dvh@asgllc.com) 2025-02-28 - 0:21:25 AM GMT- IP address: 24.6.66.89 Document e-signed by Dave Van Hoy (dvh@asgllc.com) Signature Date: 2025-02-28 - 7:28:18 AM GMT - Time Source: server- IP address: 24.6.66.89 Document emailed to floya@cupertino.gov for signature 2025-02-28 - 7:28:20 AM GMT Email viewed by floya@cupertino.gov 2025-02-28 - 7:28:29 AM GMT- IP address: 52.202.236.132 Signer floya@cupertino.gov entered name at signing as Floy Andrews 2025-03-05 - 8:27:21 PM GMT- IP address: 64.165.34.3 Document e-signed by Floy Andrews (floya@cupertino.gov) Signature Date: 2025-03-05 - 8:27:23 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Teri Gerhardt (terig@cupertino.org) for signature 2025-03-05 - 8:27:26 PM GMT Email viewed by Teri Gerhardt (terig@cupertino.org) 2025-03-05 - 8:27:32 PM GMT- IP address: 52.202.236.132 Document e-signed by Teri Gerhardt (terig@cupertino.org) Signature Date: 2025-03-05 - 8:31:27 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2025-03-05 - 8:31:29 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2025-03-05 - 8:31:36 PM GMT- IP address: 3.232.50.116 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2025-03-05 - 11:01:54 PM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2025-03-05 - 11:01:54 PM GMT 0a 0a 0a 0a 0a I Poweredby · Adobe cu,m,No Acrobat Sign First Amendment to Advanced Systems Group, LLC., Agreement for Modernization of Broadcast TV & Community Hall Integration Final Audit Report 2025-11-07 Created:2025-11-06 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAPTesevJL9tQsY_rqNjcXM2USXswXmSpP "First Amendment to Advanced Systems Group, LLC., Agreeme nt for Modernization of Broadcast TV & Community Hall Integrat ion" History Document created by Webmaster Admin (webmaster@cupertino.org) 2025-11-06 - 0:23:02 AM GMT- IP address: 35.229.54.2 Document emailed to Marilyn Pavlov (marilynp@cupertino.org) for approval 2025-11-06 - 0:30:41 AM GMT Email viewed by Marilyn Pavlov (marilynp@cupertino.org) 2025-11-06 - 0:30:49 AM GMT- IP address: 98.86.179.248 Document approved by Marilyn Pavlov (marilynp@cupertino.org) Approval Date: 2025-11-06 - 0:33:43 AM GMT - Time Source: server- IP address: 69.209.31.163 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2025-11-06 - 0:33:46 AM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2025-11-06 - 0:33:53 AM GMT- IP address: 54.91.131.193 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2025-11-06 - 2:10:14 AM GMT - Time Source: server- IP address: 71.202.76.156 Document emailed to Amy Zeno (amy@asgllc.com) for signature 2025-11-06 - 2:10:17 AM GMT Email viewed by Amy Zeno (amy@asgllc.com) 2025-11-06 - 2:12:34 AM GMT- IP address: 104.47.59.254 Document e-signed by Amy Zeno (amy@asgllc.com) Signature Date: 2025-11-06 - 2:13:08 AM GMT - Time Source: server- IP address: 73.162.121.125 Document emailed to Michael Woo (michaelw@cupertino.org) for signature 2025-11-06 - 2:13:10 AM GMT Email viewed by Michael Woo (michaelw@cupertino.org) 2025-11-06 - 2:13:17 AM GMT- IP address: 54.160.229.171 Document e-signed by Michael Woo (michaelw@cupertino.org) Signature Date: 2025-11-06 - 2:15:57 AM GMT - Time Source: server- IP address: 73.170.186.236 Document emailed to terig@cupertino.org for signature 2025-11-06 - 2:16:00 AM GMT Email viewed by terig@cupertino.org 2025-11-06 - 2:16:07 AM GMT- IP address: 54.160.229.171 Signer terig@cupertino.org entered name at signing as Teri Gerhardt 2025-11-07 - 2:16:59 AM GMT- IP address: 73.71.247.175 Document e-signed by Teri Gerhardt (terig@cupertino.org) Signature Date: 2025-11-07 - 2:17:01 AM GMT - Time Source: server- IP address: 73.71.247.175 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2025-11-07 - 2:17:03 AM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2025-11-07 - 2:17:13 AM GMT- IP address: 44.202.44.202 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2025-11-07 - 2:21:52 AM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2025-11-07 - 2:21:52 AM GMT