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24-040 CSG for Blackberry Farm Golf Course Pole Inspection - Year 4Blackberry Farm Golf Course Pole Inspection - Year 4 Page 1 of 9 Professional/Consulting Contracts /Version: February 2024 PROFESSIONAL/CONSULTING SERVICES AGREEMENT 1. PARTIES This Agreement is made by and between the City of Cupertino, a municipal corporation (“City”), and CSG Consultants Inc (“Contractor”), a Corporation for Blackberry Farm Golf Course Pole Inspection - Year 4, and is effective on the last date signed below (“Effective Date”). 2. SERVICES 2.1 Contractor agrees to provide the services and perform the tasks (“Services”) set forth in detail in Scope of Services, attached here and incorporated as Exhibit A. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID-19. 2.2 Contractor’s duties and services under this agreement shall not include preparing or assisting the City with any portion of the City’s preparation of a request for proposals, request for qualifications, or any other solicitation regarding a subsequent or additional contract with the City. The City shall at all times retain responsibility for public contracting, including with respect to any subsequent phase of this project. Contractor’s participation in the planning, discussions, or drawing of project plans or specifications shall be limited to conceptual, preliminary, or initial plans or specifications. Contractor shall cooperate with the City to ensure that all bidders for a subsequent contract on any subsequent phase of this project have access to the same information, including all conceptual, preliminary, or initial plans or specifications prepared by contractor pursuant to this agreement. 3. TIME OF PERFORMANCE 3.1 This Agreement begins on the Effective Date and ends on December 31, 2024 (“Contract Time”), unless terminated earlier as provided herein. Contractor’s Services shall begin on the effective date and shall be completed by December 31, 2024. The City’s appropriate department head or the City Manager may extend the Contract Time through a written amendment to this Agreement, provided such extension does not include additional contract funds. Extensions requiring additional contract funds are subject to the City’s purchasing policy. 3.2 Schedule of Performance. Contractor must deliver the Services in accordance with the Schedule of Performance, attached and incorporated here Exhibit B. 3.3 Time is of the essence for the performance of all the Services. Contractor must have sufficient time, resources, and qualified staff to deliver the Services on time. Blackberry Farm Golf Course Pole Inspection - Year 4 Page 2 of 9 Professional/Consulting Contracts /Version: February 2024 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will based on actual costs but that will be capped so as not to exceed $2,400.00 (“Contract Price”), based upon the scope of services in Exhibit A and the budget and rates included in Exhibit C, Compensation attached and incorporated here. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. No extra work or payment is permitted without prior written approval of City. 4.2 Invoices and Payments. Monthly invoices must state a description of the deliverable completed and the amount due for the preceding month. Within thirty (30) days of completion of Services, Contractor must submit a requisition for final and complete payment of costs and pending claims for City approval. Failure to timely submit a complete and accurate payment requisition relieves City of any further payment or other obligations under the Agreement. 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement. Contractor is not entitled to health benefits, worker’s compensation, or other benefits from the City. 5.2 Contractor’s Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Services in a competent and professional manner and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or certified to perform the Services as required by law and have procured a City Business License, if required by the Cupertino Municipal Code. 5.4 Subcontractors. Only Contractor’s employees are authorized to work under this Agreement. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Agreement will apply to any approved subcontractor. 5.5 Tools, Materials, and Equipment. Contractor will supply all tools, materials and equipment required to perform the Services under this Agreement. 5.6 Payment of Benefits and Taxes. Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its employees, agents, and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor’s business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. Blackberry Farm Golf Course Pole Inspection - Year 4 Page 3 of 9 Professional/Consulting Contracts /Version: February 2024 Should any court, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS), the Internal Revenue Service or the State Employment Development Division, determine that Contractor, or any of its employees, agents, or subcontractors, is an employee for any purpose, then Contractor agrees to a reduction in amounts payable under this Agreement, or to promptly remit to City any payments due by the City as a result of such determination, so that the City’s total expenses under this Agreement are not greater than they would have been had the determination not been made. In the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement is determined by a court of competent jurisdiction or PERS to be eligible for enrollment in PERS as an employee of City, Contractor shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City, and actual attorney’s fees incurred by City in connection with the above. 6. PROPRIETARY/CONFIDENTIAL INFORMATION In performing this Agreement, Contractor may have access to private or confidential information owned or controlled by the City, which may contain proprietary or confidential details the disclosure of which to third parties may be damaging to City. Contractor shall hold in confidence all City information provided by City to Contractor and use it only to perform this Agreement. Contractor shall exercise the same standard of care to protect City information as a reasonably prudent contractor would use to protect its own proprietary data. 7. OWNERSHIP OF MATERIALS 7.1 Property Rights. Any interest (including copyright interests) of Contractor in any product, memoranda, study, report, map, plan, drawing, specification, data, record, document, or other information or work, in any medium (collectively, “Work Product”), prepared by Contractor in connection with this Agreement will be the exclusive property of the City upon completion of the work to be performed hereunder or upon termination of this Agreement, to the extent requested by City. In any case, no Work Product shall be shown to any third-party without prior written approval of City. 7.2 Copyright. To the extent permitted by Title 17 of the U.S. Code, all Work Product arising out of this Agreement is considered “works for hire” and all copyrights to the Work Product will be the property of City. Alternatively, Contractor assigns to City all Work Product copyrights. Contractor may use copies of the Work Product for promotion only with City’s written approval. 7.3 Patents and Licenses. Contractor must pay royalties or license fees required for authorized use of any third party intellectual property, including but not limited to patented, trademarked, or copyrighted intellectual property if incorporated into the Services or Work Product of this Agreement. 7.4 Re-Use of Work Product. Unless prohibited by law and without waiving any rights, City may use or modify the Work Product of Contractor or its sub-contractors prepared or created under this Agreement, to execute or implement any of the following: Blackberry Farm Golf Course Pole Inspection - Year 4 Page 4 of 9 Professional/Consulting Contracts /Version: February 2024 (a) The original Services for which Contractor was hired; (b) Completion of the original Services by others; (c) Subsequent additions to the original Services; and/or (d) Other City projects. 7.5 Deliverables and Format. Contractor must provide electronic and hard copies of the Work Product, on recycled paper and copied on both sides, except for one single-sided original. 8. RECORDS Contractor must maintain complete and accurate accounting records relating to its performance in accordance with generally accepted accounting principles. The records must include detailed information of Contractor’s performance, benchmarks and deliverables, which must be available to City for review and audit. The records and supporting documents must be kept separate from other records and must be maintained for four (4) years from the date of City’s final payment. Contractor acknowledges that certain documents generated or received by Contractor in connection with the performance of this Agreement, including but not limited to correspondence between Contractor and any third party, are public records under the California Public Records Act, California Government Code section 6250 et seq. Contractor shall comply with all laws regarding the retention of public records and shall make such records available to the City upon request by the City, or in such manner as the City reasonably directs that such records be provided. 9. ASSIGNMENT Contractor shall not assign, sublease, hypothecate, or transfer this Agreement, or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Agreement and subject to City approval, which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. 10. PUBLICITY / SIGNS Any publicity generated by Contractor for the project under this Agreement, during the term of this Agreement and for one year thereafter, will reference the City’s contributions in making the project possible. The words “City of Cupertino” will be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announcements, interviews and newspaper articles. No signs may be posted, exhibited or displayed on or about City property, except signage required by law or this Contract, without prior written approval from the City. 11. INDEMNIFICATION 11.1 To the fullest extent allowed by law, and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend and hold harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers, and consultants (“Indemnitees”), through legal counsel acceptable to City, Blackberry Farm Golf Course Pole Inspection - Year 4 Page 5 of 9 Professional/Consulting Contracts /Version: February 2024 from and against any and all liability, damages, claims, actions, causes of action, demands, charges, losses, costs, and expenses (including attorney fees, legal costs, and expenses related to litigation and dispute resolution proceedings) of every nature, arising directly or indirectly from this Agreement or in any manner relating to any of the following: (a) Breach of contract, obligations, representations, or warranties; (b) Negligent or willful acts or omissions committed during performance of the Services; (c) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors; (d) Unauthorized use or disclosure of City’s confidential and proprietary Information; (e) Claim of infringement or violation of a U.S. patent or copyright, trade secret, trademark, or service mark or other proprietary or intellectual property rights of any third party. 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-party claim. At City’s request, Contractor will assist City in the defense of a claim, dispute, or lawsuit arising out of this Agreement. 11.3 Contractor’s duties under this section are not limited to the Contract Price, workers’ compensation payments, or the insurance or bond amounts required in the Agreement. Nothing in the Agreement shall be construed to give rise to an implied right of indemnity in favor of Contractor against City or any Indemnitee. 11.4 Contractor’s payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Agreement, or a purchase order, or other transaction. 11.5 Contractor agrees to obtain executed indemnity agreements with provisions identical to those set forth here in this Section 11 from each and every subcontractor, or any other person or entity involved by, for, with, or on behalf of Contractor in the performance of this Agreement. Failure of City to monitor compliance with these requirements imposes no additional obligations on City and will in no way act as a waiver of any rights hereunder. 11.6 This Section 11 shall survive termination of the Agreement. 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit D, and must maintain the insurance for the duration of the Agreement, or longer as required by City. City will not execute the Agreement until Cit y approves receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor’s compensation or terminating the Agreement. 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all local, state, and federal laws and regulations applicable to this Agreement. Contractor will promptly notify City of changes in the Blackberry Farm Golf Course Pole Inspection - Year 4 Page 6 of 9 Professional/Consulting Contracts /Version: February 2024 law or other conditions that may affect the Project or Contractor’s ability to perform. Contractor is responsible for verifying the employment authorization of employees performing the Services, as required by the Immigration Reform and Control Act. 13.2 Labor Laws. Contractor shall comply with all labor laws applicable to this Agreement. If the Scope of Services includes a “public works” component, Contractor is required to comply with prevailing wage laws under Labor Code Section 1720 and other labor laws. 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS), or any other protected classification. Contractor shall comply with all anti-discrimination laws, including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777, and 3077.5. Consistent with City policy prohibiting harassment and discrimination, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or its employees or sub-contractors will not be tolerated. Contractor agrees to provide records and documentation to the City on request necessary to monitor compliance with this provision. 13.4 Conflicts of Interest. Contractor shall comply with all conflict of interest laws applicable to this Agreement and must avoid any conflict of interest. Contractor warrants that no public official, employee, or member of a City board or commission who might have been involved in the making of this Agreement, has or will receive a direct or indirect financial interest in this Agreement, in violation of California Government Code Section 1090 et seq. C ontractor may be required to file a conflict of interest form if Contractor makes certain governmental decisions or serves in a staff capacity, as defined in Section 18700 of Title 2 of the California Code of Regulations. Contractor agrees to abide by the City’s rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursements or terminating this Agreement. City reserves all other rights and remedies available under the law and this Agreement, including the right to seek indemnification under Section 11 of this Agreement. 14. PROJECT COORDINATION City Project Manager. The City assigns Jimmy Tan as the City’s representative for all purposes under this Agreement, with authority to oversee the progress and performance of the Scope of Services. City reserves the right to substitute another Project manager at any time, and without prior notice to Contractor. Contractor Project Manager. Subject to City approval, Contractor assigns Nourdin Khayata as its single Representative for all purposes under this Agreement, with authority to oversee the progress and performance of the Scope of Services. Contractor’s Project manager is responsible for coordinating and scheduling the Services in accordance with the Scope of Services and the Schedule of Performance. Contractor must regularly update the City’s Project Manager about the progress with the work or any delays, as required under the Scope of Services. City written approval is required prior to substituting a new Representative. Blackberry Farm Golf Course Pole Inspection - Year 4 Page 7 of 9 Professional/Consulting Contracts /Version: February 2024 15. ABANDONMENT OF PROJECT City may abandon or postpone the Project or parts therefor at any time. Contractor will be compensated for satisfactory Services performed through the date of abandonment, and will be given reasonable time to assemble the work and close out the Services. With City’s pre-approval in writing, the time spent in closing out the Services will be compensated up to a maximum of ten percent (10%) of the total time expended to date in the performance of the Services. 16. TERMINATION City may terminate this Agreement for cause or without cause at any time. Contractor will be paid for satisfactory Services rendered through the date of termination, but final payment will not be made until Contractor closes out the Services and delivers the Work Product. 17. GOVERNING LAW, VENUE, AND DISPUTE RESOLUTION This Agreement is governed by the laws of the State of California. Any lawsuits filed related to this Agreement must be filed with the Superior Court for the County of Santa Clara, State of California. Contractor must comply with the claims filing requirements under the Government Code prior to filing a civil action in court. If a dispute arises, Contractor must continue to provide the Services pending resolution of the dispute. If the Parties elect arbitration, the arbitrator’s award must be supported by law and substantial evidence and include detailed written findings of law and fact. 18. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs. 19. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Agreement. 20. WAIVER Neither acceptance of the Services nor payment thereof shall constitute a waiver of any contract provision. City’s waiver of a breach shall not constitute waiver of another provision or breach. 21. ENTIRE AGREEMENT This Agreement represents the full and complete understanding of every kind or nature between the Parties, and supersedes any other agreement(s) and understanding(s), either oral or written, between the Parties. Any modification of this Agreement will be effective only if in writing and signed by each Party’s authorized representative. No verbal agreement or implied covenant will be valid to amend or abridge this Agreement. If there is any inconsistency between any term, clause, or provision of the main Agreement and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main Agreement shall prevail and be controlling. Blackberry Farm Golf Course Pole Inspection - Year 4 Page 8 of 9 Professional/Consulting Contracts /Version: February 2024 22. INSERTED PROVISIONS Each provision and clause required by law for this Agreement is deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. The Parties will collaborate to implement this Section, as appropriate. 23. HEADINGS The headings in this Agreement are for convenience only, are not a part of the Agreement and in no way affect, limit, or amplify the terms or provisions of this Agreement. 24. SEVERABILITY/PARTIAL INVALIDITY If any term or provision of this Agreement, or their application to a particular situation, is found by the court to be void, invalid, illegal, or unenforceable, such term or provision shall remain in force and effect to the extent allowed by such ruling. All other terms and provisions of this Agreement or their application to specific situations shall remain in full force and effect. The Parties agree to work in good faith to amend this Agreement to carry out its intent. 25. SURVIVAL All provisions which by their nature must continue after the Agreement expires or is terminated, including the Indemnification, Ownership of Materials/Work Product, Records, Governing Law, and Attorney Fees, shall survive the Agreement and remain in full force and effect. 26. NOTICES All notices, requests and approvals must be sent in writing to the persons below, which will be considered effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino Office of the City Manager 10300 Torre Ave. Cupertino, CA 95014 Attention: Jimmy Tan Email: JimmyT@cupertino.org To Contractor: CSG Consultants Inc 550 Pilgrim Dr. Foster City, CA 94404 Attention: Nourdin Khayata Email: nourdin@csgengr.com 27. EXECUTION The person executing this Agreement on behalf of Contractor represents and warrants that Contractor has full right, power, and authority to enter into and carry out all actions contemplated by this Agreement and that he or she is authorized to execute this Agreement, which constitutes a legally binding obligation of Contractor. This Agreement may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. Blackberry Farm Golf Course Pole Inspection - Year 4 Page 9 of 9 Professional/Consulting Contracts /Version: February 2024 IN WITNESS WHEREOF, the parties have caused the Agreement to be executed. CITY OF CUPERTINO CONTRACTOR A Municipal Corporation By By Name Name Title Title Date Date APPROVED AS TO FORM: CHRISTOPHER D. JENSEN Cupertino City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date nourdinkhayata nourdinkhayata Vice President Apr 25, 2024 Christopher D. Jensen Chad Mosley Director of Public Works Apr 25, 2024 Apr 25, 2024 FOSTER CITY | PLEASANTON | SAN JOSE | SACRAMENTO | NEWMAN | ORANGE March 18, 2024. Jimmy Tan, PE Assistant Director of Public Works City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Re: Pole Structural Assessment at Black Berry Golf Course by CSG Consultants, Inc. CSG is pleased to provide this letter proposal to conduct a visual structural inspection, impact test for sound and soundness, and indication of near surface dry rots or damage due to exposure of the 14 wood poles. This is a continued effort of several years of similar services provided by CSG. This service also includes a letter report on the physical condition and the structural integrity of the wood poles, to the extent information is obtained from visual inspection and sound and penetration tests. The goal is to provide quick and basic assessment of the structural integrity of the poles to evaluate the timeline available for the City of Cupertino to decide course of action to take, either to rehabilitate or to replace the poles. Task breakdown by hours: 1. site visits –total of 4 hours. 2. Analysis of information obtained from site visits 2 hour. 3. Preparation of a letter report 2 hour. 4. Inhouse Administration and Coordination 2 hours. Please confirm acceptance of this proposal and the agreement to allow CSG to perform this service at the proposed total time not to exceed 10 hours at $240.00 per hour, for a total amount not to exceed $2400.00. Should you have any questions, please do not hesitate to contact us. Thank you for the opportunity to be of service to you. Sincerely, Nourdin Khayata, P.E Engineering Construction Manager CSG Engineers, Inc. Exhibits A, B, C Exh. D-Insurance Requirements for Design Professionals & Consultant Contracts 1 Form Updated Jan. 2022 Consultant shall procure prior to commencement of Services and maintain for the duration of the contract, at its own cost and expense, the following insurance policies and coverage with companies doing business in California and acceptable to City. INSURANCE POLICIES AND MINIMUMS REQUIRED 1. Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for premises operations, products and completed operations, contractual liability, and personal and advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Consultant's policy shall be "primary and non -contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 10 (04/13). c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City’s own insurance or self - insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO CA 00 01 covering any auto (including owned, hired, and non-owned autos) with limits no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers’ Compensation: As required by the State of California, with Statutory Limits and Employer’s Liability Insurance of no less than $1,000,000 per occurrence for bodily injury or disease.  Not required. Consultant has provided written verification of no employees. 4. Professional Liability for professional acts, errors and omissions, as appropriate to Consultant’s profession, with limits no less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. If written on a claims made form: a. The Retroactive Date must be shown and must be before the Effective Date of the Contract. b. Insurance must be maintained for at least five (5) years after completion of the Services. c. If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a Retroactive Date prior to the Contract Effective Date, the Consultant must purchase “extended reporting” coverage for a minimum of five (5) years after completion of the Services. EXHIBIT D Insurance Requirements Design Professionals & Consultants Contracts Exh. D-Insurance Requirements for Design Professionals & Consultant Contracts 2 Form Updated Jan. 2022 OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers (“Additional Insureds”) are to be covered as additional insureds on Consultant’s CGL and automobile liability policies. General Liability coverage can be provided in the form of an endorsement to Consultant’s insurance (at least as broad as ISO Form CG 20 10 (11/ 85) or both CG 20 10 and CG 20 37 forms, if later editions are used). Primary Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self -insurance maintained by City, its officers, officials, employees, or volunteers shall be excess of Consultant’s insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Waiver of Subrogation Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the extent said losses are covered by the insurance policies required herein. Specifically, th e Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self-Insured Retentions Any deductible or self-insured retention must be declared to and approved by the City. At City’s option, either: the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the insured or the City. Acceptability of Insurers Insurers must be licensed to do business in California with an A.M. Best Rating of A-VII, or better. Verification of Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements (or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements prior t o commencement of the Contract. City retains the right to demand verification of compliance at any time during the Contract term. Subconsultants Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant’s insurance policies. Higher Insurance Limits If Consultant maintains broader coverage and/or higher limits than the minimums shown above, City shall be entitled to coverage for the higher insurance limits maintained by Consultant. Adequacy of Coverage City reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 2/7/2024 License # 0C36861 (415) 946-7500 24414 CSG Consultants, Inc. 550 Pilgrim Drive Foster City, CA 94404 27740 39217 37257 10046 A 1,000,000 X X CGA1414883 12/4/2023 12/4/2024 1,000,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000B X X 161001088 12/4/2023 12/4/2024 5,000,000C X X 191000608 12/4/2023 12/4/2024 10,000 5,000,000 D X 152000753 12/4/2023 12/4/2024 1,000,000 1,000,000 1,000,000 E Professional Liab X 83 OH 0489503-23 12/4/2023 Ded:$50K 5,000,000 Re: City of Cupertino, its City Council, boards and commissions, officers, employees and volunteers are included as additional insureds on GL & Auto with Waiver of Subrogation and 30 Day Notice of Cancellation per attached. Waiver of Subrogation on WC and 30 Day Notice of Cancellation on Professional per attached. 30 Day Notice of Cancellation on WC is not available. Waiver of Subrogation on Professional applies. City of Cupertino 10300 Torre Avene Cupertino, CA 95014 CSGCONS-01 CSPANGLER2 Alliant Insurance Services, Inc. 560 Mission St 6th Fl San Francisco, CA 94105 General Casualty Co of WI (QBE) North Pointe Insurance Company QBE Insurance Corporation Praetorian Insurance Company Pacific Insurance Company, Limited Aggregate X 12/4/2024 X X X X X X X INTERLINE FORM IL 70 24 06 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 70 24 06 12 Page 1 of 1 AMENDMENT — NOTICE TO OTHERS OF CANCELLATION SCHEDULE* Name and Address of Person or Organization Number of Days Notice *Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. The following is added to the policy: A.If we cancel the policy by notice to the first Named Insured, for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the person(s) or or- ganization(s) shown in the Schedule above. B.Any copy of notice per paragraph A. above will be mailed or delivered: 1. To the address corresponding to each person or organization indicated in the Schedule above; and 2. At least the number of days set forth in the Schedule prior to the cancellation date appli- cable to the policy, as advised in our notice to the first Named Insured. C.If notice per paragraph A. is mailed, proof of mail- ing will be sufficient proof of notice. D.Written notices mailed or delivered by us pursuant to the terms of this endorsement are intended only to be an advance notification to the person(s) or organization(s) named in the Schedule of this en- dorsement in the event of a pending cancellation and shall not operate or be deemed to benefit, di- rectly or indirectly, any person or organization not named in the Schedule above. All other terms and conditions of the policy remain unchanged. City of Cupertino, 10300 Torre Avenue, Cupertino, CA 95014 30 COMMERCIAL GENERAL LIABILITY CG 82 24 05 12 CG 82 24 05 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 6 PREMIER GENERAL LIABILITY COVERAGE EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A.REASONABLE FORCE Paragraph 2.a. Expected or Intended Injury under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY of SECTION I — COVERAGES within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by : a.Expected or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the i n- sured. This exclusion does not apply to "bodi- ly injury" or "property damage" resulting from the use of reasonable force to protect any person or property. B.CONTRACTUAL LIABILITY Paragraph 2.b. Contractual Liability under COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY of SECTION I — COVERAGES within the COMMERCIAL GEN- ERAL LIABILITY COVERAGE FORM is replaced by : b.Contractual Liability "Bodily injury" or "property damage" for which the insured is obligated to pay damages by reason of the assumption of liability in a con- tract or agreement. This exclusion does not apply to liability for damages: (1)That the insured would have had in the absence of the contract or agreement; or (2)Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" oc- curs subsequent to the execution of the contract or agreement. C.NON OWNED WATERCRAFT Paragraph 2.g.(2) in the Aircraft, Auto Or W a- tercraft exclusion under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY of SECTION I — COVERAGES within the COM- MERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by: g.Aircraft, Auto Or Watercraft (2)A watercraft you do not own that is: (a)less than 75 feet long; and (b)Not being used to carry persons or property for a charge. D.ELECTRONIC DATA LIABILITY 1.Paragraph 2.p. Electronic Data under COV- ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY of SECTION I — COV- ERAGES within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by: p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "elec- tronic data" that does not result from physical injury to tangible property. However, this exclusion does not apply to liability for damages because of "bodily injury". 2.The following definition is added to SEC- TION V — DEFINITIONS : "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 3.For purposes of the coverage provided for "Electronic Data", Paragraph 17. in SEC- TION V — DEFINITIONS is replaced by: 17."Property damage" means: a.Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or Policy Number: CGA1414883 Page 2 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 82 24 05 12 b.Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or c.Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "elec- tronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For purposes of this insurance, "electron- ic data" is not tangible property. E.DAMAGE TO PREMISES RENTED TO YOU 1.The last paragraph after the listed exclusions under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY of SEC- TION I — COVERAGES within the COM- MERCIAL GENERAL LIABILITY COVER- AGE FORM is replaced by: Exclusions c. through n. do not apply to "property damage" by fire; smoke from a "hostile fire"; explosion; lightning; smoke re- sulting from such explosion or lightning; coll i- sion by "mobile equipment" or leakage from fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as de- scribed in SECTION III — LIMITS OF I N- SURANCE. 2.Paragraph 6. of SECTION III — LIMITS OF INSURANCE within the COMMERCIAL GENERAL LIABLITY COVERAGE FORM is replaced by: 6.Subject to Paragraph 5. above, the Dam- age To Premises Rented To You Limit is the most we will pay in any one event un- der COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE for damages because of "property damage" from fire; smoke from a "hostile fire"; explosion; lightning; smoke resulting from such ex- plosion or lightning; collision by "mobile equipment" or leakage from fire protection systems to premises while rented to you or temporarily occupied by you with per- mission of the owner. F.MEDICAL PAYMENTS 1.Paragraph 1.a.under COVERAGE C. MEDICAL PAYMENTS of SECTION I — COVERAGES within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by: 1.Insuring Agreement a.We will pay medical expenses as de- scribed below for "bodily injury" caused by an accident: (1)On premises you own or rent; (2)On ways next to premises you own or rent; or (3)Because of your operations: Provided that: (a )The accident takes place in the "coverage territory" and during the policy period; (b)The expenses are incurred and reported to us within three years of the date of the accident; and (c)The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonable require. G.SUPPLEMENTARY PAYMENTS SUPPLEMENTARY PAYMENTS — COVERAG- ES A AND B of SECTION I COVERAGES within the COMMERCIAL GENERAL LIABILITY COV- ERAGE FORM is replaced by: 1.We will pay, with respect to any claim we investigate or settle, or any "suit" against an insured we defend: a.All expenses we incur. b.Up to $5,000 for cost of bail bonds re- quired 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 fur- nish these bonds. c.The cost of bonds to release attac h- ments, but only for bond amounts within the applicable limit of insurance. We do 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 $500 a day because of time off from work. e.All costs taxed against the "insured" in any "suit". f.Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the appl i- cable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. Policy Number: CGA1414883 CG 82 24 05 12 Includes copy righted material of Insurance Services Office, Inc., with its permission. Page 3 of 6 g.All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, of- fered to pay, or deposited in court the part of the judgment that is within the applic a- ble limit of insurance. These payments will not reduce the limits of insurance. 2.If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the "suit", we will defend that inde m- nitee if all of the following conditions are met: a.The "suit" against the indemnitee seeks damages for which the insured has as- sumed the liability of the indemnitee in a contract or agreement that is an "insured contract"; b.This insurance applies to such liability as- sumed by the insured; c.The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured in the same "insured contract"; d.The allegations in the "suit" and the i n- formation we know about the "occur- rence" are such that no conflict appears to exist between the interests of the in- sured and the interests of the indemnitee; e.The indemnitee and the insured ask us to conduct and control the defense of that i n- demnitee against such "suit" and agree that we can assign the same counsel to defend the insured and the indemnitee; and f.The indemnitee: (1)Agrees in writing to: (a)Cooperate with us in the invest i- gation, settlement or defense of the "suit"; (b)Immediately send us copies of any demands, notices, sum- monses or legal papers received in connection with the "suit"; (c)Notify any other insurer whose coverage is available to the i n- demnitee; and (d)Cooperate with us with respect to coordinating other applicable insurance available to the i n- demnitee; and (2)Provides us with written authoriz a- tion to: (a)Obtain records and other infor- mation related to the "suit"; and (b)Conduct and control the defense of the indemnitee in such "suit". Our obligation to defend an insured's i n- demnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of i n- surance in the payment of judgments or settlements or the conditions set forth above, or the terms of the agreement de- scribed in Paragraph f. above, are no longer met. H.FELLOW EMPLOYEE COVERAGE — SUPERVISOR OR HIGHER Paragraph 2.a .(1) of SECTION II — WHO IS AN INSURED within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM does not apply to the following: Your supervisory or management "employees" for "bodily injury" only. Damages owed to an injured co-"employee" or "volunteer worker" will be reduced by any amount paid or available to the injured co-"employee" or "volunteer worker" under any other valid and collectible insurance. I.NEWLY ACQUlRED ORGANIZATIONS Paragraph 3.a. of SECTION II — WHO IS AN INSURED within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by : a.Coverage under this provision is afforded only until the end of the current policy period. J.BROAD FORM NAMED INSURED The following is added to SECTION I I — WHO IS AN INSURED within the COMMERCIAL GEN- ERAL LIABILITY COVERAGE FORM : Throughout this policy the words "you" and "your" refer to any corporation or other business organ i- zation, other than a joint venture, in which the first Named Insured has or acquires during the policy period an ownership interest of more than 50% and is subject to the management control of the first Named Insured or its subsidiaries, and which is domiciled within the United States of America or its territories or possessions. K.AMENDMENT OF AGGREGATE LIMIT OF INSURANCE The General Aggregate Limit Of Insurance refer- enced in Paragraph 2. of SECTION III — LIMITS OF INSURANCE within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM applies separately to: 1.Each of your "locations" owned by or rented to you; and Policy Number: CGA1414883 Page 4 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 82 24 05 12 2.Each of your projects away from premises owned by or rented to you. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. L.KNOWLEDGE OF OCCURRENCE The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM : Knowledge of an "occurrence", offense, claim or "suit" by your agent, servant or "employee" shall not be considered knowledge by you unless you, your insurance manager or any other person you designate has received notice of the "occur- rence", offense, claim or "suit" from your agent, servant, or "employee." M.OTHER INSURANCE Paragraph 4.b.(1)(a) in the Other Insurance condition of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS within the COMMERCIAL GENERAL LIABILITY COVER- AGE FORM is replaced by : 4.Other Insurance b.Excess Insurance (1)This insurance is excess over: (a)any of the other insurance, whether primary, excess, contin- gent or on any other basis: (i)That is Fire, Extended Cov- erage, Builders Risk; Installa- tion Risk or similar coverage for "your work"; (ii)That is insurance covering Fire; smoke from a "hostile fire"; explosion; lightning; smoke resulting from such explosion or lightning; coll i- sion by "mobile equipment" or leakage from fire protec- tion systems for premises while rented to you or tempo- rarily occupied by you with permission of the owner; or (iii) That is insurance to cover your liability as a tenant for "proper- ty damage" to premises while rented to you or temporarily occupied by you with permi s- sion of the owner; or (iv)If the loss arises out of the maintenance or use of aircraft, "autos", or watercraft to the extent not subject to Para- graph 2.g. Aircraft, Auto Or Watercraft under COVER- AGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY of SECTION I – COVERAGES within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. N.UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following is added to Paragraph 6. Representations of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM: Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Commercial General Liability Coverage Form or at any time during the policy period will not inval i- date or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after the exposure or hazard is discovered. O.WAIVER OF SUBROGATION The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS within the COMMER- CIAL GENERAL LIABILITY COVERAGE FORM: This condition does not apply to any person or organization to which you waived this condition by written contract or agreement, but only to the extent that subrogation is waived prior to the "bodily injury" or "property damage" under a contract with that person or organization. P.LIMITED WORLDWIDE LIABILITY COVERAGE The following is added to SECTION IV — CON- DITIONS within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM : Policy Number: CGA1414883 CG 82 24 05 12 Includes copy righted material of Insurance Services Office, Inc., with its permission. Page 5 of 6 Expanded Coverage Territory 1.If a "suit" is brought in a part of the "coverage territory" that is outside the United States of America (including its territories and posses- sions), Puerto Rico or Canada, and we are prevented by law, or otherwise, from defend- ing the insured, the insured will initiate a de- fense of the "suit". We will reimburse the i n- sured, under Supplementary Payments, for any reasonable and necessary expenses i n- curred for the defense of a "suit" seeking damages to which this insurance applies, that we would have paid had we been able to ex- ercise our right and duty to defend. If the insured becomes legally obligated to pay sums because of damages to which this insurance applies in a part of the "coverage territory" that is outside the United States of America (including its territories and posses- sions), Puerto Rico or Canada, and we are prevented by law, or otherwise, from paying such sums on the insured's behalf, we will re- imburse the insured for such sums. 2.All payments or reimbursements we make for damages because of judgments or settl e- ments will be made in U.S. currency at the prevailing exchange rate at the time the i n- sured became legally obligated to pay such sums. All payments or reimbursements we make for expenses under Supplementary Payments will be made in U.S. currency at the prevailing exchange rate at the time the expenses were incurred. 3.Any disputes between you and us as to whether there is coverage under this policy must be filed in the courts of the United States of America (including its territories and possessions), Puerto Rico or Canada. 4.The insured must fully maintain any coverage required by law, regulation or other governmen- tal authority during the policy period, except for reduction of the aggregate limits due to pay- ments of claims, judgments or settlements. Failure to maintain such coverage required by law, regulation or other governmental authori- ty will not invalidate this insurance. However, this insurance will apply as if the required coverage by law, regulation or other govern- mental authority was in full effect. For purposes of this coverage only, the following is added to Paragraph 4.b.(1)(a) under Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS within the COMMERCIAL GENERAL LIABILITY COVER- AGE FORM: If the insured's liability to pay damages is deter- mined in a "suit" brought outside the United States of America (including its territories and possessions), Puerto Rico or Canada; or That is coverage required by law, regulation or other governmental authority in a part of the "coverage territory" that is outside the United States of America (including its territories and possessions), Puerto Rico or Canada. For purposes of this coverage only, Paragraph 4. of SECTION V — DEFINITIONS within the COMMERCIAL GENERAL LIABILITY COVER- AGE FORM is replaced by : 4."Coverage territory" means anywhere in the world with the exception of any country or j u- risdiction which is subject to trade or other economic sanction or embargo by the United States of America. Q.BODILY INJURY REDEFINITION Paragraph 3. of SECTION V. — DEFINITIONS within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by : 3."Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, injury or illness or emotional distress and/or death resulting from any of these at any time. R.INSURED CONTRACT — LEASE OF PREMISES Paragraph 9.a. of SECTION V — DEFINITIONS within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by : 9."Insured contract" means: a.a contract for lease of premises. Howev- er, that portion of the contract for a lease of premises that indemnifies any person or organization for "property damage" by fire; smoke from a "hostile fire", expl o- sion; lightning; smoke resulting from such explosion or lightning; collision by "mobile equipment" or leakage from fire protection systems to premises while rented to you or temporarily occupied by you with pe r- mission of the owner is not an "insured contract". S.LIBERALIZATION If we revise this endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. Policy Number: CGA1414883 Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 82 24 05 12 T.GOOD SAMARITAN SERVICES 1.Under SECTION II — WHO IS AN INSURED, paragraph 2.d., the following is added: This exclusion does not apply to your em- ployees or volunteer workers, other than an employed or volunteer physician, rendering "Good Samaritan services". 2.The following definition is added to SECTION V — DEFINITIONS: "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. Policy Number: CGA1414883 COMMERCIAL GENERAL LIABILITY CG 81 02 08 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 81 02 08 05 Includes copyrighted material of Insurance Services Office Inc., with its permission. Copyright, Insurance Services Office, Inc. 2002 Page 1 of 2 CONTRACTORS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (called additional insured) whom you are required to add as an additional insured on this policy under a written contract or written agreement; but the written contract or written agreement must be: 1.Currently in effect or becoming effective during the term of this policy; and 2.Executed prior to the “bodily injury”, “property damage” or “personal and advertising injury”. B.The insurance provided to the additional insured is limited as follows: 1.That person or organization is an additional insured only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused in whole or in part, by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf. in the performance of your operations for the additional insured. 2.The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These Limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. 3.The coverage provided to the additional insured by this endorsement and paragraph f. of the definition of “insured contract” under DEFINITIONS (SECTION V) do not apply to “bodily injury” or “property damage” arising out of the “products-completed operations hazard” unless required by the written contract or written agreement. 4.The insurance provided to the additional insured does not apply to: “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: a.The preparing, approving, or failure to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b.Supervisory, inspection, architectural or engineering activities. 5.We have no duty to defend or indemnify an additional insured under this endorsement: a.For any liability due to negligence attributable to any person or entity other than you or those acting on your behalf in the performance of your operations for the additional insured. b.For any loss which occurs prior to our named insured commencing operations at the location of the loss. c.Until we receive written notice of a claim or “suit” from the additional insured as required in the Duties In The Event of Occurrence, Offense Claim or Suit Condition. C.As respects the coverage provided under this endorsement, the COMMERCIAL GENERAL LIABILITY CONDITIONS (SECTION IV) are amended as follows: 1.The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition: An additional insured under this endorsement will as soon as practicable: Policy Number: CGA1414883 Page 2 of 2 Includes copyrighted material of Insurance Services Office Inc., with its permission. Copyright, Insurance Services Office, Inc. 2002 CG 81 02 08 05 (1)Give written notice of an occurrence or an offense to us which may result in a claim or “suit” under this insurance; (2)Agree to trigger or activate any other insurance which the additional insured has, which is primary, for a loss we cover under this Coverage Part by tendering the defense to the insurers of all such other insurance. 2.As respects the coverage provided under this endorsement, Paragraph 4.b. of the Other Insurance Condition is deleted and replaced by the following: 4. Other Insurance b. Excess Insurance This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless the written contract or agreement described in A. above specifically requires that this insurance be provided on either a primary basis or a primary and noncontributory basis. Policy Number: CGA1414883 CA-BA-2003 (12-20) © , 2020 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE ENHANCEMENT Name of Insured: Policy Number: Endorsement Number: Effective Date of Endorsement: Name of Insurer: This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PRELIMINARY STATEMENT – This endorsement broadens coverage provided under the Coverage Form. However, further limitations and exclusions may apply to these coverages. Read all provisions of this endorsement and the entire policy carefully to determine all rights, duties, coverages and limitations provided. A.BROADENED WHO IS AN INSURED N.LOAN/LEASE PAYOFF COVERAGE B.NEWLY ACQUIRED OR FORMED ORGANIZATIONS O.CUSTOM SIGNS AND DECORATIONS C.LIABILITY COVERAGE EXTENSIONS SUPPLEMENTARY PAYMENTS P.HIRED AUTO PHYSICAL DAMAGE D.FELLOW EMPLOYEE COVERAGE Q.EXTENDED EMPLOYEE HIRED AUTO PHYSICAL DAMAGE E.POLLUTION LIABILITY – BROADENED COVERAGE FOR COVERED AUTOS R.EXTRA EXPENSE – STOLEN AUTOS F.EXTENDED TOWING S.PARKED AUTO COLLISION WAIVER OF DEDUCTIBLE G.PHYSICAL DAMAGE COVERAGE EXTENSIONS T.DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS H.RENTAL REIMBURSEMENT U.WAIVER OF SUBROGATION I.AIRBAG COVERAGE V.CANCELLATION CONDITION J.AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT W.UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS K.TAPES, RECORDS AND DISCS COVERAGE X.POLICY PERIOD, COVERAGE TERRITORY L.PHYSICAL DAMAGE DEDUCTIBLE – SINGLE DEDUCTIBLE AND GLASS REPAIR Y.DEFINITION OF BODILY INJURY AMENDED M.PERSONAL EFFECTS COVERAGE CSG Consultants, Inc. 12/4/2023 North Pointe Insurance Company 161001088 CA-BA-2003 (12-20) © , 2020 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 6 PROVISIONS A.BROADENED WHO IS AN INSURED SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended by the addition of the following: Employees As Insureds Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. Employee Hired Auto Any "employee" of yours is an "insured" while using an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. Additional Insured By Written Contract Any person or organization to whom you are required by a written contract or agreement to provide additional insured status is an "insured" under Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under Section II.A.1. Who Is An Insured of this Coverage Form. The written contract or agreement must be in effect during the policy period shown in the Declarations and must have been executed prior to the "bodily injury" or "property damage". B.NEWLY ACQUIRED OR FORMED ORGANIZATIONS Throughout this policy, the words “you” and “your” also refer to any subsidiary organization you newly acquire or form and over which you maintain 50% or more ownership interest, but only if there is no similar insurance available to that organization. However: 1.“Insured” does not include any subsidiary organization where similar insurance is unavailable because the organization has exhausted that policy’s limits of insurance or the other carrier has become insolvent. 2.The coverage does not apply to an "accident" which occurred prior to your acquisition or formation of the organization. 3.Unless you notify us to add coverage to your policy, the coverage under this provision is afforded only until: a.The 180th day after you acquire or form the organization, or b.The end of the policy period, whichever is earlier. C.LIABILITY COVERAGE EXTENSIONS SUPPLEMENTARY PAYMENTS SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Payments, Paragraphs (2) and (4) are replaced by the following: (2)Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. D.FELLOW EMPLOYEE COVERAGE SECTION II — COVERED AUTOS LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire that is not a bus, motorcycle or van used to transport “employees”. This Fellow Employee Coverage is excess over any other collectible insurance. E.POLLUTION LIABILITY — BROADENED COVERAGE FOR COVERED AUTOS 1.SECTION II – COVERED AUTOS LIABILITY COVERAGE, B. Exclusions is amended as follows: a.11. Pollution, Paragraph a. applies only to liability assumed under a contract or agreement. b.With respect to the coverage afforded by Paragraph 1.a. above, 6. Care, Custody Or Control does not apply. 2.Changes in Definitions For the purposes of this endorsement, SECTION V — DEFINITIONS, Paragraph D. is replaced by the following: D."Covered pollution cost or expense" means any cost or expense arising out of: 1.Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or CA-BA-2003 (12-20) © , 2020 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 6 2. Any claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to or assessing the effects of "pollutants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (1) The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. This Pollution Liability Coverage is subject to an Annual Aggregate Limit of Liability of $100,000. F. EXTENDED TOWING SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 2. Towing And Labor is replaced by the following: 2. Extended Towing And Labor We will pay for towing and labor costs each time a covered "auto" is disabled. All labor must be performed at the place of disablement. The most we will pay under this Extended Towing coverage is $750 per occurrence. No deductible applies to this coverage. G. PHYSICAL DAMAGE COVERAGE EXTENSIONS SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions is amended as follows: a. Transportation Expenses The amount we will pay for temporary transportation expense is increased to $75 per day to a maximum of $3,000. b. Loss of Use Expenses The amount we will pay for loss of use is increased to $75 per day and to a maximum limit of $1,000. H. RENTAL REIMBURSEMENT 1. This coverage applies only to a covered "auto" described or designated in the Schedule or in the Declarations as carrying physical damage coverage. 2. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of coverage you have on each covered "auto". 3. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: a. The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you; or b. 30 days. 4. Our payment is limited to the lesser of the following amounts: a. Necessary and actual expenses incurred; or b. $75 per day 5. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. 6. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for CA-BA-2003 (12-20) © , 2020 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 6 under SECTION III — PHYSICAL DAMAGE COVERAGE in Paragraph A.4. Coverage Extensions. No deductible applies to this coverage. I. AIRBAG COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph 3.a. is amended by the addition of the following: This exclusion does not apply to the unintended discharge of an airbag. J. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT SECTION III – PHYSICAL DAMAGE COVERAGE is amended as follows: 1. C. Limits Of Insurance, Paragraph 1.b. is amended as follows: The $1,000 limit is increased to $1,500. 2. D. Deductible does not apply to coverage provided in C. Limits Of Insurance, Paragraph 1.b. K. TAPES, RECORDS AND DISCS COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph 4.a. is replaced by the following: a. Tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment except when the tapes, records, discs or other similar audio, visual or data electronic devices: (1) Are your property or that of a family member, and (2) Are in a covered "auto" at the time of "loss". The most we will pay for "loss" under this Tapes, Records and Discs Coverage is $200. No Physical Damage Coverage deductible applies to this coverage. L. PHYSICAL DAMAGE DEDUCTIBLE — SINGLE DEDUCTIBLE AND GLASS REPAIR SECTION III — PHYSICAL DAMAGE COVERAGE, D. Deductible is replaced by the following: D. Deductible For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations prior to the application of the Limit of Insurance. Any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or lightning. When two or more covered "autos" sustain "loss" in the same occurrence, the total of all the "loss" for all the involved covered "autos" will be reduced by a single deductible, which will be the largest of all the deductibles applying to all such covered "autos." No deductible applies to glass damage if the glass is repaired rather than replaced. M. PERSONAL EFFECTS COVERAGE 1. If you purchase Comprehensive Coverage on this policy for a stolen owned "auto", we will pay up to $1,000 for "personal effects" stolen with the "auto". 2. "Personal effects" as used in this extension means tangible property that is worn or carried by the "insured". "Personal effects" does not include tools, jewelry, money, securities, radar or laser detectors, or tapes, records, discs or similar audio, visual or data electronic equipment. No deductible applies to this coverage. The insurance provided by this extension is excess over any other collectible insurance. N. LOAN/LEASE PAYOFF COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: In the event of a total "loss" to a covered "auto" shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of the "loss"; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. Security deposits not returned by the lessor; d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases. O. CUSTOM SIGNS AND DECORATIONS In the event of a total “loss” to a vehicle insured for auto physical damage coverage on this policy, in addition to the ACV of the vehicle, we will pay the actual cost to repair or replace signage or custom paint details up to $5,000. CA-BA-2003 (12-20) © , 2020 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 6 P. HIRED AUTO PHYSICAL DAMAGE If hired "autos" are covered "autos" for Liability Coverage and if Physical Damage Coverage of Comprehensive, Specified Causes of Loss, or Collision are provided under this Coverage Form for any "auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire of like kind and use subject to the following limit: The most we will pay for any one “loss” is the lesser of the following: 1. $100,000 per “accident”; 2. Actual Cash Value; or 3. The cost of repair. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. No deductible applies to "loss" caused by fire or lightning. This Hired Auto Physical Damage coverage is excess over any other collectible insurance. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. Q. EXTENDED EMPLOYEE HIRED AUTO PHYSICAL DAMAGE SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, Paragraph b. is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "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 that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. EXTRA EXPENSE – STOLEN AUTOS SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions is amended by the addition of the following: Extra Expense – Stolen Autos We will pay the extra expense of returning a stolen covered “auto” to you if: (1) The Declarations indicates that Comprehensive Coverage is provided for the stolen covered “auto”; or (2) The Declarations indicates that Specified Causes of Loss is provided for the stolen covered “auto”. However, the most we will pay for any extra expense under this Coverage Extension is $1,000. S. PARKED AUTO COLLISION WAIVER OF DEDUCTIBLE SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph D. Deductible is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to a covered "auto" of the private passenger type or light weight truck with a maximum gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer while it is: 1. In the charge of an "insured"; 2. Legally parked; and 3. Unoccupied. The "loss" must be reported to the police within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization in the automobile business. T. DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit Or Loss, Paragraph a. is replaced by the following: a. In the event of "accident", claim, "suit" or "loss", you, your insurance manager or any other person you designate must give us or our authorized representative prompt notice of such "accident" or "loss". Include: (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. Knowledge of an "accident", claim, "suit" or "loss" by your agent, servant or "employee" shall not be considered knowledge by you unless you, your insurance manager or any other person you designate has received notice of the "accident", claim, "suit" or "loss" from your agent, servant, or "employee". CA-BA-2003 (12-20) © , 2020 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 6 U. WAIVER OF SUBROGATION SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us is amended as follows: This condition does not apply to any person or organization to which you waived this condition by written contract or agreement, but only to the extent that subrogation is waived prior to the "accident" or "loss" under a contract with that person or organization. V. CANCELLATION CONDITION Subject to any statute or regulation requiring a longer time period, if we cancel for any reason other than nonpayment of premium, we will mail or deliver to the first Named Insured written notice of cancellation at least 90 days prior to the effective date of cancellation. W. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation Or Fraud is amended by the addition of the following: Any unintentional failure to disclose all exposures or hazards existing as of the effective date of this Coverage Form or at any time during the policy period will not invalidate or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. X. POLICY PERIOD, COVERAGE TERRITORY SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 7. Policy Period, Coverage Territory is replaced by: 7. Policy Period, Coverage Territory Under this Coverage Form, we cover "accidents" and "losses" occurring: a. During the policy period shown in the Declarations; and b. Within the coverage territory. The coverage territory is: (1) The United States of America; (2) The territories and possessions of the United States of America; (3) Puerto Rico; (4) Canada; and (5) Anywhere else in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 30 days or less, provided that the "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada, or in a settlement we agree to. We also cover "loss" to, or "accidents" involving, a covered "auto" while being transported between any of these places. Y. DEFINITION OF BODILY INJURY AMENDED SECTION V — DEFINITIONS, Paragraph C. is replaced the following: C. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, injury or illness or emotional distress and/or death resulting from any of these at any time. None of the extensions provided under this coverage endorsement apply if coverage is more specifically identified elsewhere in the policy or endorsements, for which a premium charge is made or a higher limit is identified. Under no circumstances is any limit provided under this extension to be combined with a limit provided elsewhere in the policy or endorsements. All other terms and conditions of this policy remain unchanged. COMMERCIAL AUTO CA 80 02 05 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 80 02 05 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ADDITIONAL INSURED BY CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. ADDITIONAL INSURED BY CONTRACT OR AGREEMENT Paragraph A.1. Who Is an Insured of SECTION II — LIABILITY COVERAGE is amended to in- clude the following: Any person or organization to whom you become obligated to include as an additional insured un- der this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with re- spect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: 1.The coverage and/or limits of this policy, or 2.The coverage and/or limits required by said contract or agreement. Policy Number: 161001088 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) 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 en - force 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 anyone not named in the Schedule. Schedule 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 Policy No.Endorsement No. Insured Premium $ Insurance Company Countersigned by WC 00 03 13 (Ed. 4-84)Copyright 1983 National Council on Compensation Insurance. Blanket Waiver of Subrogation as required by written contract. 12/4/2023 152000753 CSG Consultants, Inc. Praetorian Insurance Company CSG for Blackberry Farm Golf Course Pole Inspection - Year 4 Final Audit Report 2024-04-25 Created:2024-03-28 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAATb3c0o2nI67hX4Wvl-vQnN9MXP9-8ao "CSG for Blackberry Farm Golf Course Pole Inspection - Year 4" History Document created by Webmaster Admin (webmaster@cupertino.org) 2024-03-28 - 4:36:10 PM GMT- IP address: 35.229.54.2 Document emailed to Jindy Gonzalez (jindyg@cupertino.org) for approval 2024-03-28 - 4:43:21 PM GMT Email viewed by Jindy Gonzalez (jindyg@cupertino.org) 2024-03-28 - 4:49:29 PM GMT- IP address: 104.47.74.126 Document approved by Jindy Gonzalez (jindyg@cupertino.org) Approval Date: 2024-03-28 - 4:50:29 PM GMT - Time Source: server- IP address: 174.85.102.16 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2024-03-28 - 4:50:31 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2024-03-28 - 10:40:16 PM GMT - Time Source: server- IP address: 71.204.144.228 Document emailed to nourdin@csgengr.com for signature 2024-03-28 - 10:40:18 PM GMT Email viewed by nourdin@csgengr.com 2024-04-25 - 8:29:21 PM GMT- IP address: 198.189.159.82 Signer nourdin@csgengr.com entered name at signing as nourdinkhayata 2024-04-25 - 8:29:58 PM GMT- IP address: 198.189.159.82 Document e-signed by nourdinkhayata (nourdin@csgengr.com) Signature Date: 2024-04-25 - 8:30:00 PM GMT - Time Source: server- IP address: 198.189.159.82 Document emailed to christopherj@cupertino.org for signature 2024-04-25 - 8:30:02 PM GMT Email viewed by christopherj@cupertino.org 2024-04-25 - 8:31:23 PM GMT- IP address: 104.47.74.126 Signer christopherj@cupertino.org entered name at signing as Christopher D. 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