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HomeMy WebLinkAbout25-057 Placeworks_Amendment #1 dated 11-12-25 NOE for the Idlewild Townhomes Project for the City of Cupertino1 FIRST AMENDMENT TO AGREEMENT 1025 BETWEEN THE CITY OF CUPERTINO AND PLACEWORKS, INC. FOR NOTICE OF EXEMPTION (NOE) FOR THE IDLEWILD TOWNHOMES PROJECT FOR THE CITY OF CUPERTINO This First Amendment to Agreement 1025 is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and PlaceWorks, Inc., a Corporation (“Contractor”) whose address is 2040 Bancroft Way, Suite 400, Berkeley, CA 94704, and is made with reference to the following: RECITALS: A. On April 9, 2025, Agreement 1025 (“Agreement”) was entered into by and between City and Contractor for Notice of Exemption (NOE) for the Idlewild Townhomes Project for the City of Cupertino. B. The Original Agreement and First Amendment are collectively referred to as the “Agreement” unless otherwise indicated. C. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. Paragraph 4.1 of the Agreement is modified to read as follows: 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 $74,516.00 (“Contract Price”), based upon the scope of services in Exhibit A and the budget and rates included in Exhibit C-1, 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. Exhibit C of the Agreement is replaced with a new Exhibit C-1 attached hereto. 2. Paragraph 12 of the Agreement is modified to read as follows: INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit D-1, 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 2 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. Exhibit-D of the Agreement is replaced with Exhibit D-1, attached hereto. 3. 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. IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CITY OF CUPERTINO PLACEWORKS, INC. By By Title Title Date Date APPROVED AS TO FORM Senior Assistant City Attorney ATTEST: City Clerk Date EXPENDITURE DISTRIBUTION Item PO Number Amount Base 2025-480 $72,776.00 1st Amendment $1,740.00 Total $74,516.00 Principal 11/12/2025 Benjamin Fu Director of Community Development 11/12/2025 11/12/2025 SERVICE AUTHORIZATION AMENDMENT NO. 1 PROJECT NO. COCU-34.0 DATE 10/28/2025 PROJECT NAME Idlewild Townhomes CEQA Exemption AGREEMENT BETWEEN: CLIENT City of Cupertino CONSULTANT PlaceWorks STREET ADDRESS 10300 Torre Avenue STREET ADDRESS 3 MacArthur Place, Suite 1100 CITY STATE AND ZIP Cupertino, CA 95014 CITY STATE AND ZIP Santa Ana, CA 92707 CONTACT Gian Martire CONTACT Michelle Monnig for Vivian Kha Herein Her This Amendment No. 1 PlaceWorks (Consultant), a California Corporation, and City of Cupertino (Client). RECITAL Tasks Previous Contract Amount Amount of this Amendment New Contract Amount TASK 0 CONTINGENCY $ 3,466.00 $ 0.00 $ 3,466.00 TASK A.1 PROJECT MANAGEMENT AND MEETING $ 4,230.00 $ 0.00 $ 4,230.00 TASK A.2 KICK-OFF MEETING $ 945.00 $ 0.00 $ 945.00 TASK A.3 PROJECT DESCRIPTION $ 1,905.00 $ 0.00 $ 1,905.00 TASK B.1 PEER REVIEW $ 4,600.00 $ 0.00 $ 4,600.00 TASK B.2 ENVIRONMENTAL ANALYSIS $ 47,730.00 $ 0.00 $ 47,730.00 TASK C.1 NOTICE OF EXEMPTION DOCUMENTATION $ 6,800.00 $ 0.00 $ 6,800.00 TASK C.2 FILING THE NOE $3,100.00 $1,740.00 $4,840.00 TOTAL: $ 72,776.00 $ 1,740.00 $ 74,516.00 EXHIBIT C-1 Service Authorization | Page 2 CONSULTANT: CONSULTANT PlaceWorks STREET ADDRESS 3 MacArthur Place, Suite 1100 CITY STATE AND ZIP Santa Ana, CA 92707 AUTHORIZED REPRESENTATIVE Kara Kosel TITLE Vice President, Finance 10/28/2025 PlaceWork Date CLIENT: CLIENT City of Cupertino STREET ADDRESS 10300 Torre Avenue CITY STATE AND ZIP Cupertino, CA 95014 AUTHORIZED REPRESENTATIVE TITLE Client Date 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 $ none $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) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY B 2,000,000 1000068067251 5,000,000 LOS-002212059-33 1,000,000 4,000,000 X 25674 4,000,000 Irvine, CA 92614 N X Comp/Coll Deductibles BI & PD Ded. $5,000 07/01/2025 5 07/01/2026 07/15/2025 07/01/2026 BA-1N96406A-25-43-G B 2,000,000 1,000,000 Travelers Property Casualty Co. Of America 1,000,000 X C X Liability. Waiver of subrogation is applicable where required by written contract with respect to General and Auto Liability. 1,000 X 07/11/2025 07/15/2025 5,000,000 Re: IS/MND Cupertino CA The City of Cupertino, its city council, boards and commissioners, officers, employees, and volunteers are included as additional insured where required by written contract with respect to General and Auto Liability. See Acord 101 X Contractors Pollution Cupertino, CA 95014 City of Cupertino This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to General X A Falcon Insurance Group CN115158923-01-01-25-26 Each Claim/Aggregate 5,000 07/01/2026 1,000,000 EX-6J328756-25-43 1,000,000 13604 50,000 1,000,000 07/01/2026 UB-7K728676-25-43-G 17901 Von Karman Avenue, Suite 1100 Marsh Risk & Insurance Services X (949) 399-5800; License #0437153 Attn: NewportBeach.CertRequest@marsh.com/F: 212-948-4323 3 MacArthur Place, Suite 1100 PlaceWorks, Inc Santa Ana, CA 92707 FRS-H-P-PL-00013383-01 07/01/2025 10300 Toree Ave. Y Y 07/01/2025 B Y 07/01/2026 Starr Surplus Lines Insurance Company Y Errors & Omissions-Claims Made Ded. $50,000.00 Retro Dates: See 2nd Page ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 22 Irvine When required by written contract, the insurer will provide 30 days’ notice of cancellation to the certificate holder as respects to Auto Liability and Workers Compensation policies for any reason other than non- payment of premium, subject to policy terms and conditions. Certificate of Liability Insurance CN115158923 Marsh Risk & Insurance Services 3 MacArthur Place, Suite 1100 PlaceWorks, Inc Santa Ana, CA 92707 25 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover­ age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en­ dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A.BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF B.BLANKET ADDITIONAL INSURED USE -INCREASED LIMIT C EMPLOYEE HIRED AUTO I.PHYSICAL DAMAGE -TRANSPORTATION• EXPENSES -INCREASED LIMITD.EMPLOYEES AS INSURED E.SUPPLEMENTARY PAYMENTS -INCREASED LIMITS F.HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS G.WAIVER OF DEDUCTIBLE -GLASS PROVIS IONS A.BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur­ ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un­ til the 180th day after you acquire or form the or­ ganization or the end of the policy period, which­ ever is earlier. B.BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A. 1 ., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi­ tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which J.PERSONAL PROPERTY K.AIRBAGS L.NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M.BLANKET WAIVER OF SUBROGATION N.UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured'' under the Who ls An Insured provision contained in Section II. C.EMPLOYEE HIRED AUTO 1.The following is added to Paragraph A. 1 .. Who Is An Insured, of SECTION II -COV­ ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name with your permission, while performing duties related to the conduct of your busi­ ness. 2.The following replaces Paragraph b. in S.S., Other Insurance, of SECTION IV -BUSI­ NESS AUTO CONDITIONS: b.For Hired Auto Physical Damage Cover­ age, the following are deemed to be cov­ ered "autos" you own: (1)Any covered "auto" you lease, hire, rent or borrow; and (2)Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name. with your CA T3 53 0215 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy Number: BA-1N96406A-24-43-GEffective Date: 07/01/2025 POLICY NUMBER: BA-1N96406A-25-43-G COMMERCIAL AUTO ISSUE DATE: 07-12-25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE -PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE OF AD DITIONAL INSURED PERSONS OR ORGANIZATIONS PROVISIONS 1.The following is added to Paragraph c. in A. 1 ., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization designated in the Schedule Of Additional Insured Persons Or Organizations who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that designated person's or organization's liability for the conduct of another "insured". 2.The following is added to Paragraph 5., Other Insurance, in B., General Conditions, of SECTION IV -BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which the person or organization designated in the Schedule Of Additional Insured Persons Or Organizations is the first named insured when the written contract or agreement between you and that designated person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. CA T4 42 0216 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. ENERGY & ENVIRONMENTAL LIABILITY SSEE-0237 02 24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED, PRIMARY AND NONCONTRIBUTORY AND WAIVER OF SUBROGATION AMENDATORY ENDORSEMENT Policy Number: FRS-H-P-PL-00013383-01 Named Insured: Placeworks, Inc. Effective Date: 07/15/2025 at 12:01 A.M. This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. CONTRACTORS' POLLUTION LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM SITE POLLUTION LIABILITY COVERAGE FORM SCHEDULE I Where Required By Wntten Contraci It is hereby agreed as follows: 1.SECTION II -WHO IS AN INSURED is amended to include the following: a.Any person(s) or organization(s) that you are required to include as an additional insured under this policyby written contract or written agreement or that is listed in the SCHEDULE above is an additional insuredunder this policy. Such additional insured status applies only with respect to liability arising out of "yourwork" for or on behalf of that person(s) or organization(s) pursuant to such written contract or writtenagreement. However, the insurance afforded to such additional insured(s): (1)only applies to the extent permitted by law; and (2)will not be broader than that which you are required by the written contract or written agreement toprovide for such additional insured(s). b.With respect to the insurance afforded to the additional insured(s), SECTION Ill -LIMITS OF INSURANCEis amended to include the following: The most we will pay on behalf of the additional insured(s) 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. SSEE-0237 02 24 Copyright© Starr Surplus Lines Insurance Company. All rights reserved. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Policy No. 10006 806725 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED NOTICE OF CANCELLATION ENDORSEMENT This endorsement modifies insurance provided under the following: 00 .. ERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABIUIY COVERAGE PART In consideration of the premium charged and solely with respect to the coverage parts shown above1 it is hereby agreed that the Cammon Provisions, Section VI -Cammon Conditions is amended by the addition of the following: Limited Nalice or Cancellation In the event that we cancel ttis Policy for any reason other� non-payment of premilSII and; a. The effedive date of cancellation is prior to 1he expiration dale of ttis Policy; and b.You are under an existing written conlraclual obligation to notify a certificate holder when ttis Policy is canceled and have provided to us1 either direclly or 1hrough your broker of record, the email address of a contact at each such certificate holder; and c.We received this information after you received nofioe of cancellation of this Policy and prior to the effective date of cancellation, via an electronic spreadsheet that is acceptable to usl We will provide notice of cancellation via email to each such certificate holder within thirty (30) days of your providing such information to us. Prod c:A our emaiHng the notice of cancellation, using the information provided by )1)111 will serve as evidence that we have satisfied our obligations under Dis condition. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN01650117 Page 1 of 1 Policy No. FRS-H-P-PL-00013383-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED NOTICE OF CANCELLATION ENDORSEMENT This endorsement modifies insurance provided under the following: ERRORS AND OMISSIONS LIABILITY COVERAGE PART In consideration of the premium charged and solely with respect to the coverage parts shown above1 it is hereby agreed that the Cammon Provisions, Section VI -Cammon Conditions is amended by the addition of the following: Limited Nalice or Cancellation In the event that we cancel ttis Policy for any reason other� non-payment of premilSII and; a. The effedive date of cancellation is prior to 1he expiration dale of ttis Policy; and b.You are under an existing written conlraclual obligation to notify a certificate holder when ttis Policy is canceled and have provided to us1 either direclly or 1hrough your broker of record, the email address of a contact at each such certificate holder; and c.We received this information after you received nofioe of cancellation of this Policy and prior to the effective date of cancellation, via an electronic spreadsheet that is acceptable to usl We will provide notice of cancellation via email to each such certificate holder within thirty (30) days of your providing such information to us. Prod c:A our emaiHng the notice of cancellation, using the information provided by )1)111 will serve as evidence that we have satisfied our obligations under Dis condition. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN01650117 Page 1 of 1 � TRAVELERSJ ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) • 003 POLICY NUMBER: UB-7K728676-25-43-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 07-14-25 ST ASSIGN: PAGE 1 OFl POLICY NUMBER: BA-1N96406A-25-43-G ISSUE DATE: 08-13-25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION-NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY CANCELLATION: PERSON OR ORGANIZATION: CITY OF CUPERTINO ADDRESS: PROVISIONS 10300 TORRE AVENUE CUPERTINO CA 95014 SCHEDULE Number of Days Notice: 30 If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 0519 © 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 � TRAVELERSJ ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 RJ (00) • 006 POLICY NUMBER: UB-7K728676-25-43-G NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX -CONDITIONS: Notice Of Cancellation To Designated Persons Or Organizations 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. SCHEDULE Name and Address of Designated Persons or Organizations: CITY OF CUPERTINO 10300 TORRE AVENUE CUPERTINO. CA 95014 All other terms and conditions of this policy remain unchanged. Number of Days Notice 30 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 Policy No. Endorsement No. Premium$ Insurance Company Page 1 of 1 DATE OF ISSUE: 08-13-25 ST ASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. Exh. D-1 - Insurance Requirements for Design Professionals & 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. 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 D-1 Insurance Requirements Design Professionals & Consultants Contracts Exh. D-1 - Insurance Requirements for Design Professionals & 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-1 - Insurance Requirements for Design Professionals & 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. NOE for the Idlewild Townhomes Project for the City of Cupertino Final Audit Report 2025-11-13 Created:2025-11-12 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAACIeNpyu8Gb0mGCE2BQFi01kjJ3mY1CJn "NOE for the Idlewild Townhomes Project for the City of Cupertin o" History Document created by Webmaster Admin (webmaster@cupertino.org) 2025-11-12 - 6:30:02 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2025-11-12 - 6:33:39 PM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2025-11-12 - 6:33:50 PM GMT- IP address: 44.204.222.177 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2025-11-12 - 9:38:06 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Terri McCracken (tmccracken@placeworks.com) for signature 2025-11-12 - 9:38:09 PM GMT Email viewed by Terri McCracken (tmccracken@placeworks.com) 2025-11-12 - 10:49:14 PM GMT- IP address: 73.71.121.61 Document e-signed by Terri McCracken (tmccracken@placeworks.com) Signature Date: 2025-11-12 - 10:55:47 PM GMT - Time Source: server- IP address: 73.71.121.61 Document emailed to Michael Woo (michaelw@cupertino.org) for signature 2025-11-12 - 10:55:49 PM GMT Email viewed by Michael Woo (michaelw@cupertino.org) 2025-11-12 - 10:55:58 PM GMT- IP address: 3.87.39.181 Document e-signed by Michael Woo (michaelw@cupertino.org) Signature Date: 2025-11-12 - 11:46:43 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Benjamin Fu (benjaminf@cupertino.org) for signature 2025-11-12 - 11:46:45 PM GMT Email viewed by Benjamin Fu (benjaminf@cupertino.org) 2025-11-12 - 11:46:54 PM GMT- IP address: 3.82.154.48 Document e-signed by Benjamin Fu (benjaminf@cupertino.org) Signature Date: 2025-11-12 - 11:54:49 PM GMT - Time Source: server- IP address: 174.194.194.151 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2025-11-12 - 11:54:51 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2025-11-12 - 11:54:57 PM GMT- IP address: 3.87.24.3 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2025-11-13 - 3:58:40 AM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2025-11-13 - 3:58:40 AM GMT