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23-104 Professional Consultant CoC & KMVT _Amendment #1 dated 6-3-25 for City Channel Government Access support (1)KMVT for City Channel Government Access support1 FIRST AMENDMENT TO AGREEMENT 23-104 BETWEEN THE CITY OF CUPERTINO AND KMVT FOR CITY CHANNEL GOVERNMENT ACCESS SUPPORT This First Amendment to Agreement 23-104 is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and KMVT Community Television (“Contractor”), a Corporation, whose address is 900 San Antonio Road, Palo Alto, CA 94303, and is made with reference to the following: RECITALS: A. On September 19, 2023, Agreement 23-104 (“Agreement”) was entered into by and between City and Contractor for City Channel Government Access Support. B. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. Paragraph 2 of the Agreement is modified to read as follows: 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 A1. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID-19. Exhibit A of the Agreement is replaced with a new Exhibit A1 attached hereto. 2. Paragraph 3.2 of the Agreement is modified to read as follows: Schedule of Performance. Contractor must deliver the Services in accordance with the Schedule of Performance, attached and incorporated here as Exhibit B1. Exhibit B of the Agreement is replaced with a new Exhibit B1 attached hereto. 3. Paragraph 4.1 of the Agreement is modified to read as follows: 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 $156,990.00 (“Contract Price”), based upon the scope of services in Exhibit A1 and the budget and rates included in Exhibit C1, 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. Exhibit C of the Agreement is replaced with a new Exhibit C1 attached hereto. 4. 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. 2 IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CITY OF CUPERTINO By Title Date APPROVED AS TO FORM MICHAEL K. WOO Senior Assistant City Attorney ATTEST: City Clerk Date KMVT COMMUNITY TELEVISION By Title Date EXPENDITURE DISTRIBUTION Base Agreement $114,490 First Amendment $ 42,500 Total $156,990 James R Connor Executive Director 05/30/2025 CTO 06/01/2025 06/03/2025 EXHIBIT A1 EXHIBIT A1 SCOPE OF SERVICES & DELIVERABLES CONTRACTOR and CITY will work closely together to ensure a successful and professional operation of the CITY’S City Channel Government Access Channels 26 and 99. The Scope of Services includes outcome measures that define an acceptable level of service delivery expected from CONTRACTOR. 1. Executive Summary KMVT15 is submitting this proposal as an addendum to the professional video production services currently under contract with the City of Cupertino, referred to as "City". This addendum addresses adding two types of events to the current contract as follows: A. The Silicon Valley Clean Energy Authority Board meeting once per month with live streaming to YouTube and the City’s government channel. The Silicon Valley Clean Energy Authority will be referred to as SVCEA. B. The Cupertino Television and Video Production (CTVP) meetings that will be recorded in at our studio, located at 2500 Old Middlefield Way, Suite F, Mountain View, CA 94043. Each of these two items will be billed to the City of Cupertino as per the terms and conditions outlined below. 2. Scope of Work Overview: • Video recording of Silicon Valley Clean Energy Board meeting once per month with live streaming to YouTube and the City’s government channel. The cost for each SVCEA Board meeting is outlined, actual hours will be invoiced. • The CTVP meeting will be recorded using staff provided by KMVT on an as needed basis to support the CTVP shows. 3. Proposed Cost structure • The budget for the CTVP shows is $2000 per year. The Public Access billing rates for each CTVP show ar EXHIBIT A1 ◦ Two -hour minimum (one staffer, engineer): $90.00 ◦ Two -hour minimum (two staffers): $180.00 ◦ Two -hour minimum (three staffers): $270.00 ◦ For a not-to-exceed amount of $2000, for content created under the CVTP MOU with Cupertino to create content that is approved by Cupertino and promoting a City event, program, initiative or function. •The SVCEA Board meeting cost is attached to the end of this proposal. 4. Compliance and Legal • KMVT complies with all local, state, and federal regulations. • KMVT will provide Proof of insurance and relevant certifications. 5. Next Steps Contractor is prepared to begin the SVCEA board meeting productions in March 2025 with an existing team, who have experience in the Cupertino Production Room. The CTVP events will be scheduled with the CTVP Team, contractor will update on schedule. Additional Services: • Video recording of Silicon Valley Clean Energy Board meeting once per month with live streaming to YouTube and the City’s government channel. The cost for each SVCEA Board meeting is outlined, actual hours will be invoiced. • The CTVP meeting will be recorded using staff provided by KMVT on an as needed basis to support the CTVP shows. EXHIBIT B1 Schedule of Performance The work outlined in the Scope of Work (Exhibit A1 & C1) will be completed by July 31, 2026. EXHIBIT C1 COMPENSATION 1. Broadcast Technician or Camera Operation Technician: CONTRACTOR will receive an hourly fee of $90.00 per staff member, summing to an annual compensation of $18,900.00, based on an estimated 210 hours of service per contract year. Responsibility for video production, direction, broadcasting, recording and pre and post processing is held by the CITY. 2. Video Engineer: CONTRACTOR will receive an hourly fee of $135.00 per staff member, summing to an annual compensation of $6,480.00, based on an estimated 48 hours of services per contract year. 3. Editor/Producer: CONTRACTOR will receive an hourly fee of $105/hour per staff member, summing to an annual fee of $4,200, based on an estimated 40 hours of services per contract year. 4. Multi-Camera Shoot – Production of Original Programming for City Events: Per the CITY's request, the CONTRACTOR shall receive $2,250.00 per City event, totaling $6,750.00 annually based on an estimated three (3) six-hour events per contract year. Each event involves two (2) CONTRACTOR-owned cameras, two (2) Camera Operation Technicians, one (1) Editor/Producer. The CONTRACTOR is responsible for all video production, direction, broadcasting, recording, and pre/post processing tasks. 5. Additional services will include video recording and live streaming of 17 SVCEA Board meetings at $2,500 each, with a total compensation of $42,500. 6. The total estimated compensation for all services over the contract term is $78,830.00. This is an estimate only, and the final compensation may vary based on the actual number of hours worked. CONTRACTOR will invoice the CITY monthly for actual hours worked, and the CITY agrees to pay such invoices. 7. CONTRACTOR may, at CITY request, provide the following optional original programming services for the prices indicated. Programs would be recorded for later viewing (aired on EXHIBIT C1 cable channel and website) with basic slate graphic at beginning and end.  Cupertino Community Event with Truck: In accordance with the directives of the CITY, CONTRACTOR will receive a fee for each event of $2,750. An event encompasses the utilization of two (2) CONTRACTOR-owned cameras, two (2) Camera Operations Technician, and one (1) Editor/Producer for a six (6) hour event. 8. Total Compensation shall not exceed $156,990 for the first three years of this agreement. Exh. D-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 Insurance Requirements Design Professionals & Consultants Contracts Exh. D-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-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. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/16/2025 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 be endorsed. If SUBROGATIONIS 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). PRODUCER KRAFT LAKE INS AGENCY INC/PHS 81152026 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251 CONTACT NAME: PHONE (A/C, No, Ext): (866) 467-8730 FAX (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED MOUNTAIN VIEW COMMUNITY TELEVISION, INC 2500 OLD MIDDLEFIELD WAY STE F MOUNTAIN VIEW CA 94043-2346 INSURER A : Sentinel Insurance Company Ltd. 11000 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/Y YYY)LIMITS A COMMERCIAL GENERAL LIABILITY X X 81 SBA BG2341 08/14/2024 08/14/2025 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence)$1,000,000 X General Liability MED EXP (Any one person)$10,000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $4,000,000 POLICY PRO- JECT X LOC PRODUCTS - COMP/OP AGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS- MADE 81 SBA BG2341 08/14/2024 08/14/2025 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A PER STATUTE OTH- ER Y/N E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Please see Additional Remarks Schedule Acord 101 Form Attached CERTIFICATE HOLDER CANCELLATION City of Cupertino 10300 TORRE AVE CUPERTINO CA 95014-3202 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DEDUCTIBLE $1,000 ROY CHETTY AGENCY 408-872-2500 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/16/2025 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 be endorsed. If SUBROGATIONIS 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). PRODUCER HUB INTERNATIONAL INS SVCS INC/PHS 72255611 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251 CONTACT NAME: PHONE (A/C, No, Ext): (866) 467-8730 FAX (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED MOUNTAIN VIEW COMMUNITY TELEVISION, INC 2500 OLD MIDDLEFIELD WAY STE F MOUNTAIN VIEW CA 94043-2346 INSURER A : Hartford Accident and Indemnity Company 22357 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/Y YYY)LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG OTHER: A AUTOMOBILE LIABILITY X X 72 UEC CK9030 08/30/2024 08/30/2025 COMBINED SINGLE LIMIT (Ea accident)$1,000,000 X ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS- MADE EACH OCCURRENCE AGGREGATE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A PER STATUTE OTH- ER Y/N E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Please see Additional Remarks Schedule Acord 101 Form Attached CERTIFICATE HOLDER CANCELLATION City of Cupertino 10300 TORRE AVE CUPERTINO CA 95014-3202 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ROY CHETTY AGENCY 408-872-2500 ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC# : ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY KRAFT LAKE INS AGENCY INC/PHS NAMED INSURED MOUNTAIN VIEW COMMUNITY TELEVISION, INC 2500 OLD MIDDLEFIELD WAY STE F MOUNTAIN VIEW CA 94043-2346 POLICY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 NAIC CODE EFFECTIVE DATE:SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER:ACORD 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Notice of Cancellation will be provided in accordance with Form SS1223, attached to this policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SS0008, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SS0008, attached to this policy. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008, attached to this policy. ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC# : ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY HUB INTERNATIONAL INS SVCS INC/PHS NAMED INSURED MOUNTAIN VIEW COMMUNITY TELEVISION, INC 2500 OLD MIDDLEFIELD WAY STE F MOUNTAIN VIEW CA 94043-2346 POLICY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 NAIC CODE EFFECTIVE DATE:SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER:ACORD 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Certificate holder is an additional insured per the Commercial Auto Broad Form Endorsement HA9916, attached to this policy. Notice of Cancellation will be provided in accordance with Form IH0313, attached to this policy. Coverage is primary and non- contributory per the Commercial Auto Broad Form Endorsement HA9916, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Commercial Auto Broad Form Endorsement HA9916, attached to this policy. WLTR005 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 May 16, 2025 City of Cupertino 10300 TORRE AVE CUPERTINO CA 95014-3202 Account Information: Policy Holder Details :MOUNTAIN VIEW COMMUNITY TELEVISION, INC Contact Us Need Help? Chat online or call us at (866) 467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 (866) 467-8730 (800) 447-7649 SERVICE.TX@THEHARTFORD.COM (866) 467-8730 (800) 447-7649 HUB INTERNATIONAL INS SVCS INC/PHS The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 Select Customer Insurance Center Policyholder, please call us at: Agent, please call us at: INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: Agent, please call us at: between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. THE HARTFORD SELECT CUSTOMER INSURANCE CENTER 72 UEC CK9030 DX CHANGE NUMBER: 003 03/11/25 MOUNTAIN VIEW COMMUNITY TELEVISION HUB INTERNATIONAL INS SVCS INC/PHS .532 ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT. IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE. FORM NUMBERS OF ENDORSEMENTS ADDED TO THIS POLICY AT ENDORSEMENT ISSUE: SEE ABOVE FOR COMPANY NAME ENTIRE CONTRACT: IH03130611 03/11/25 Form HM 12 01 01 07T THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES This endorsement forms a part of the Policy numbered below: POLICY NUMBER: Policy Change Effective Date: Named Insured: Producer's Name: Pro Rata Factor: Description of Change(s): Countersigned by (Where required by law) Authorized Representative Date THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 03 13 06 11 Page 1 of 1 © 2011, The Hartford NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A.If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B.If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proofofnotice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 (866) 467-8730 (800) 447-7649 SERVICE.TX@THEHARTFORD.COM (866) 467-8730 (800) 447-7649 HUB INTERNATIONAL INS SVCS INC/PHS The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 Select Customer Insurance Center Policyholder, please call us at: Agent, please call us at: INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: Agent, please call us at: between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. THE HARTFORD SELECT CUSTOMER INSURANCE CENTER 72 UEC CK9030 DX CHANGE NUMBER: 002 03/11/25 MOUNTAIN VIEW COMMUNITY TELEVISION HUB INTERNATIONAL INS SVCS INC/PHS .532 ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT. IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. HARTFORD ACCIDENT AND INDEMNITY COMPANY CA2048(S) IS/ARE ADDED. THE FOLLOWING CA2048 SEQUENCE NO(S) APPLY: 01 THE FOLLOWING ENDORSEMENT(S) IS/ARE ADDED: WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 03/11/25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form HA 99 10 01 07T MISCELLANEOUS CHANGE ENDORSEMENT POLICY NUMBER: This endorsement modifies insurance provided under the following: This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. (Premium adjustment, if any, for the addition, deletion or other change described in this endorsement is shown in the Premium Column below.) Effective Date: Named Insured: Producer's Name: Pro Rata Factor: Description of Change: Countersigned by (Where required by law) Authorized Representative Date WAIVER OF TRANSFER OF RIGHTS OF RECOVERY POLICY NUMBER:72 UEC CK9030 PAGE 2 72 UEC CK9030 DX FORMS ADDED CA04441013 CA20481013 Form HA 99 10 01 07T MISCELLANEOUS CHANGE ENDORSEMENT (Continued) POLICY NUMBER: 72 UEC CK9030 CHANGE NUMBER: 002 CITY OF CUPERTINO POLICY NUMBER:COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. POLICY NUMBER:72 UEC CK9030 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY BUSINESS AUTO COVERAGE FORM 72 UEC CK9030 CHANGE NUMBER: 002 CITY OF CUPERTINO ATT: FINANCE DEPARTMENT 10300 TORRE AVE CUPERTINO, CA 95014 POLICY NUMBER:COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1.of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2.of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. DESIGNATED INSURED BUSINESS AUTO COVERAGE FORM 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 (866) 467-8730 (800) 447-7649 SERVICE.TX@THEHARTFORD.COM (866) 467-8730 (800) 447-7649 HUB INTERNATIONAL INS SVCS INC/PHS The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 Select Customer Insurance Center Policyholder, please call us at: Agent, please call us at: INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: Agent, please call us at: between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. THE HARTFORD SELECT CUSTOMER INSURANCE CENTER 72 UEC CK9030 DX CHANGE NUMBER: 002 03/11/25 MOUNTAIN VIEW COMMUNITY TELEVISION HUB INTERNATIONAL INS SVCS INC/PHS .532 ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT. IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. HARTFORD ACCIDENT AND INDEMNITY COMPANY CA2048(S) IS/ARE ADDED. THE FOLLOWING CA2048 SEQUENCE NO(S) APPLY: 01 THE FOLLOWING ENDORSEMENT(S) IS/ARE ADDED: WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 03/11/25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form HA 99 10 01 07T MISCELLANEOUS CHANGE ENDORSEMENT POLICY NUMBER: This endorsement modifies insurance provided under the following: This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. (Premium adjustment, if any, for the addition, deletion or other change described in this endorsement is shown in the Premium Column below.) Effective Date: Named Insured: Producer's Name: Pro Rata Factor: Description of Change: Countersigned by (Where required by law) Authorized Representative Date PAGE 2 72 UEC CK9030 DX FORMS ADDED CA04441013 CA20481013 Form HA 99 10 01 07T MISCELLANEOUS CHANGE ENDORSEMENT (Continued) POLICY NUMBER: 72 UEC CK9030 CHANGE NUMBER: 002 CITY OF CUPERTINO POLICY NUMBER:COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. 72 UEC CK9030 CHANGE NUMBER: 002 CITY OF CUPERTINO ATT: FINANCE DEPARTMENT 10300 TORRE AVE CUPERTINO, CA 95014 POLICY NUMBER:COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1.of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2.of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 (866) 467-8730 (866) 467-8730 (866) 467-8730 (866) 467-8730 KRAFT LAKE INS AGENCY INC/PHS The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 Select Customer Insurance Center Policyholder, please call us at: Agent, please call us at: INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: Agent, please call us at: between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. THE HARTFORD SELECT CUSTOMER INSURANCE CENTER 001 03/11/25 08/14/24 08/14/25 81 SBA BG2341 DV MOUNTAIN VIEW COMMUNITY TELEVISION INC 2500 OLD MIDDLEFIELD WAY STE F MOUNTAIN VIEW CA 94043 03/11/25 002 KRAFT LAKE INS AGENCY INC/PHS 152026 SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE PROPERTY OPTIONAL COVERAGES APPLICABLE TO ALL LOCATIONS ARE ADDED COMPUTERS AND MEDIA COVERAGE FORM SS 04 41 DEDUCTIBLE: $ 1,000 FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - PERSON-ORGANIZATION PRO RATA FACTOR: 1.000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Page Process Date: Policy Effective Date: Policy Expiration Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: Named Insured and Mailing Address; Policy Change Effective Date: Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: Agent Name: Code: POLICY CHANGES: 81 SBA BG2341 ADDITIONAL INSURED - PERSON-ORGANIZATION ST. FRANCIS HIGH SCHOOL THE BROTHERS OF HOLY CROSS 1885 MIRAMONTE AVE MOUNTAIN VIEW, CA 94040 CITY OF MOUNTAIN VIEW ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS 500 CASTRO ST MOUNTAIN VIEW, CA 94042 CITY OF SUNNYVALE, ITS OFFICIALS, OFFICERS, EMPLOYEES AND AGENTS ATTN: PURCHASING DIVISION PO BOX 3707 SUNNYVALE, CA 94088 CITY OF CUPERTINO ITS CITY COUNCIL BOARDS AND COMMISSION OFFICERS OFFICIALS AGENTS EMPLOYEES AND SERVANTS VOLUNTEERS AND CONSULTANTS 10300 TORRE AVE CUPERTINO, CA 95014-3255 CITY OF LOS ALTOS, ITS OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS 1 SAN ANTONIO RD SAN ANTONIO, CA 94022 CENTRAL COAST SECTION 6830 VIA DEL ORO STE 103 SAN JOSE, CA 95119 WEST VALLEY MISSION COMMUNITY COLLEGE DISTRICT 14000 FRUITVALE AVE SARATOGA, CA 95070 FOOTHILL DE ANZA COMMUNITY COLLEGE DISTRICT 1245 EL MONTE RD LOS ALTOS, CA 94022 RE: 1400 TERRA BELLA AVE STE M MOUNTAIN VIEW, CA 94043 CITY OF FOSTER CITY, ESTERO MUNICIPAL IMPROVEMENT DISTRICT, ITS COUNCIL, OFFICERS, BOARDS, COMMISSIONS, EMPLOYEES AND AGENTS 001 001 (CONTINUED ON NEXT PAGE) 03/11/25 08/14/25 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 12 00 11 85 T SEQ. NO. Printed in U.S.A. Page Process Date: Expiration Date: 81 SBA BG2341 ADDITIONAL INSURED - PERSON-ORGANIZATION 610 FOSTER CITY BLVD FOSTER CITY, CA 94404 CITY OF CUPERTINO ATT: FINANCE DEPARTMENT 10300 TORRE AVE CUPERTINO, CA 95014 LGS RECREATION AND ITS BOARD OF TRUSTEES, AGENTS, OFFICERS, REPRESENTATIVES, EMPLOYEES, CONSULTANTS, AND VOLUNTEERS AS ADDITIONAL INSUREDS UNDER GENERAL LIABILITY POLICY. COVERAGE IS PRIMARY AND NON CONTRIBUTORY LGS RECREATION 123 E MAIN ST LOS GATOS, CA 95030 TRACY UNIFIED SCHOOL DISTRICT, ITS GOVERNING BOARD, ITS OFFICERS, ITS AGENTS, ITS EMPLOYEES AND ITS VOLUNTEERS 1875 W LOWELL AVE TRACY, CA 95376 001 002 (CONTINUED ON NEXT PAGE) 03/11/25 08/14/25 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 12 00 11 85 T SEQ. NO. Printed in U.S.A. Page Process Date: Expiration Date: 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 (866) 467-8730 (866) 467-8730 (866) 467-8730 (866) 467-8730 KRAFT LAKE INS AGENCY INC/PHS The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 Select Customer Insurance Center Policyholder, please call us at: Agent, please call us at: INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: Agent, please call us at: between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. THE HARTFORD SELECT CUSTOMER INSURANCE CENTER 001 (CONTINUED ON NEXT PAGE) 03/14/25 08/14/24 08/14/25 81 SBA BG2341 DV MOUNTAIN VIEW COMMUNITY TELEVISION INC 2500 OLD MIDDLEFIELD WAY STE F MOUNTAIN VIEW CA 94043 03/14/25 004 KRAFT LAKE INS AGENCY INC/PHS 152026 SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE PROPERTY OPTIONAL COVERAGES APPLICABLE TO ALL LOCATIONS ARE ADDED COMPUTERS AND MEDIA COVERAGE FORM SS 04 41 DEDUCTIBLE: $ 1,000 PRO RATA FACTOR: 1.000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Page Process Date: Policy Effective Date: Policy Expiration Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: Named Insured and Mailing Address; Policy Change Effective Date: Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: Agent Name: Code: POLICY CHANGES: 002 03/14/25 08/14/24 08/14/25 81 SBA BG2341 004 BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSURED(S) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 ADDITIONAL INSURED #1 - OWNERS, LESSEE OR CONTRACTORS IS ADDED FORM SS4171 NAME CITY OF CUPERTINO ATT: FINANCE DEPARTMENT ADDRESS 10300 TORRE AVECUPERTINO, CA 95014-3202 FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: SS 41 71 12 19 Form SS 12 11 04 05 T Page Process Date: Policy Effective Date: Policy Expiration Date: POLICY CHANGE (Continued) Policy Number: Policy Change Number: CITY OF CUPERTINO ATT FINANCE DEPARTMENT 10300 TORRE AVECUPERTINO, CA 95014-3202 81 SBA BG2341 CHANGE NUMBER:004 03/14/25 08/14/25 POLICY NUMBER : THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations: Section C. – Who Is An Insured is amended to include the following: a.The person(s) or organization(s) shown in the Schedule on the Declarations is also an additional insured, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" and at the location designated and described in the Location And Description Of Completed Operations Schedule in the Declarations performed for that additional insured and included in the "products-completed operations hazard". b.With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1)The preparing, approving, editing of or failure to prepare or approve, shop drawings, maps, opinions, reports, surveys, change orders, field orders, designs, drawings, specifications, warnings, recommendations, permit applications, payment requests, manuals or instructions; (2)Supervisory, inspection, quality control, architectural, engineering or surveying activities or services; (3)Maintenance of job site safety, construction administration, construction contracting, construction management, computer consulting or design software development or programming service, or selection of a contractor or programming service; (4)Monitoring, sampling, or testing service necessary to perform any of the services included in (1), (2)or (3) above; (5)Supervision, hiring, employment, training or monitoring of others who are performing any of the services included in (1), (2)or (3)above; c.The insurance afforded to these additional insureds only applies to the extent permitted by law. FormSS41711219 Page 1 of 1 Process Date: Policy Expiration Date: © 2019, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission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vW XIVQ *EMPYVI XS TVSZMHI WYGL RSXMGI XS XLI GIVXMJMGEXI LSPHIVW [MPP RSX EQIRH SV I\XIRH XLI HEXI XLI GERGIPPEXMSR FIGSQIW IJJIGXMZI RSV [MPP MX RIKEXI GERGIPPEXMSR SJ XLI TSPMG] *EMPYVI XS WIRH RSXMGI WLEPP MQTSWI RS PMEFMPMX] SJ ER] OMRH YTSR XLI 'SQTER] SV MXW EKIRXW SV VITVIWIRXEXMZIW 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 (866) 467-8730 (866) 467-8730 (866) 467-8730 (866) 467-8730 KRAFT LAKE INS AGENCY INC/PHS The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 Select Customer Insurance Center Policyholder, please call us at: Agent, please call us at: INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: Agent, please call us at: between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. THE HARTFORD SELECT CUSTOMER INSURANCE CENTER 001 03/11/25 08/14/24 08/14/25 81 SBA BG2341 DV MOUNTAIN VIEW COMMUNITY TELEVISION INC 2500 OLD MIDDLEFIELD WAY STE F MOUNTAIN VIEW CA 94043 03/11/25 003 KRAFT LAKE INS AGENCY INC/PHS 152026 SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE PROPERTY OPTIONAL COVERAGES APPLICABLE TO ALL LOCATIONS ARE ADDED COMPUTERS AND MEDIA COVERAGE FORM SS 04 41 DEDUCTIBLE: $ 1,000 FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 WAIVER OF SUBROGATION PRO RATA FACTOR: 1.000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Page Process Date: Policy Effective Date: Policy Expiration Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: Named Insured and Mailing Address; Policy Change Effective Date: Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: Agent Name: Code: POLICY CHANGES: 81 SBA BG2341 WAIVER OF SUBROGATION CITY OF CUPERTINO, ITS CITY COUNCIL, BOARDS AND COMMISSIONS, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS, VOLUNTEERS AND CONSULTANTS 10300 TORRE AVE CUPERTINO, CA 95014 CITY OF CUPERTINO ATT: FINANCE DEPARTMENT 10300 TORRE AVE CUPERTINO, CA 95014 002 001 03/11/25 08/14/25 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 12 00 11 85 T SEQ. NO. Printed in U.S.A. Page Process Date: Expiration Date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for City Channel Government Access support Final Audit Report 2025-06-03 Created:2025-05-27 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAqLXz0f_amLnNGnLTbKNA3qtaOxB2PslQ "KMVT for City Channel Government Access support" History Document created by Webmaster Admin (webmaster@cupertino.org) 2025-05-27 - 3:47:00 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2025-05-27 - 3:50:47 PM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2025-05-27 - 3:51:05 PM GMT- IP address: 52.1.140.55 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2025-05-27 - 4:14:41 PM GMT - Time Source: server- IP address: 71.202.76.156 Document emailed to jconnor@futureofreading.com for signature 2025-05-27 - 4:14:55 PM GMT Email viewed by jconnor@futureofreading.com 2025-05-27 - 5:04:02 PM GMT- IP address: 172.226.36.16 Webmaster Admin (webmaster@cupertino.org) added alternate signer Jim Connor (jconnor@kmvt15.org). The original signer jconnor@futureofreading.com can still sign. 2025-05-29 - 11:01:20 PM GMT- IP address: 64.165.34.3 Document emailed to Jim Connor (jconnor@kmvt15.org) for signature 2025-05-29 - 11:01:22 PM GMT Email viewed by Jim Connor (jconnor@kmvt15.org) 2025-05-29 - 11:16:47 PM GMT- IP address: 98.248.49.153 Signer jconnor@futureofreading.com entered name at signing as James R Connor 2025-06-01 - 11:12:02 PM GMT- IP address: 98.248.49.153 Document e-signed by James R Connor (jconnor@futureofreading.com) Signature Date: 2025-06-01 - 11:12:04 PM GMT - Time Source: server- IP address: 98.248.49.153 Document emailed to Teri Gerhardt (terig@cupertino.org) for signature 2025-06-01 - 11:12:16 PM GMT Email viewed by Teri Gerhardt (terig@cupertino.org) 2025-06-01 - 11:12:25 PM GMT- IP address: 44.198.60.171 Document e-signed by Teri Gerhardt (terig@cupertino.org) Signature Date: 2025-06-02 - 1:30:32 AM GMT - Time Source: server- IP address: 73.158.167.141 Document emailed to Michael Woo (michaelw@cupertino.org) for signature 2025-06-02 - 1:30:45 AM GMT Email viewed by Michael Woo (michaelw@cupertino.org) 2025-06-02 - 1:31:00 AM GMT- IP address: 54.146.162.113 Document e-signed by Michael Woo (michaelw@cupertino.org) Signature Date: 2025-06-03 - 8:03:45 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2025-06-03 - 8:03:59 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2025-06-03 - 8:04:06 PM GMT- IP address: 34.237.140.171 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2025-06-03 - 9:58:29 PM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2025-06-03 - 9:58:29 PM GMT