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11-039 Agreement,CSG Consultants, Plan Review, Inspection and Scanning Services
1 CONSULTANT SERVICES AGREEMENT BETWEEN THE CITY AND CSG CONSULTANTS CUPERTINO THIS AGREEMENT, dated APRIL 25,2011_, is entered into by and between the City of Cupertino, a municipal Corporation ( "City "), and CSG CONSULTANTS, Inc. ( "Consultant "). RECITALS A. The City desires to contract for the provision of professional services for Plan Review, Inspection and Scanning Services. B. Consultant's qualifications have been reviewed and accepted by the City. Consultant desires to perform such professional services under agreement with the City. NOW, THEREFORE, in consideration of the terms and conditions contained herein, the City and Consultant agree as follows: AGREEMENT I. Services. Subject to the terms and conditions set forth in this Agreement ( "Agreement "), Consultant shall provide the professional services as described in the attached Exhibit A 2. Payment. (a) Payment for Professional Services. Payments shall be made upon receipt of invoices. Invoices shall contain details regarding dates of work performed and shall be for amounts in accord with those set forth in the attached Exhibit 13 (b) Additional Services. Any additional services required beyond those set forth in this Agreement shall be performed only if mutually agreed to in writing by the City and Consultant. 3. Responsible Personnel. The professional services described in this Agreement shall be performed by or under the supervision of a registered civil or structural engineer or licensed architect. Consultant shall assign only competent personnel to perform services pursuant to this Agreement. In the event that the City, in its sole discretion, at any time during the term of this Agreement, desires the removal of any person or persons assigned by Consultant to perform services pursuant to this Agreement, Consultant shall remove any such person immediately upon receiving notice thereof from the City. Page 1 of 9 4. Facilities and Equipment. Consultant shall.. at its sole cost and expense, furnish all facilities and equipment that may be required for furnishing services pursuant to the Agreement. 5. Subcontracting. Consultant shall not be permitted to subcontract any portion of this Agreement without the express written consent of the City. 6. Independent Contractor. Both parties understand that Consultant, its agents, employees and independent contractors are and shall at all times remain as to the City wholly independent contractors. Neither the City nor any of its officers or employees shall have any control over the manner by which the Consultant performs this Agreement and shall only dictate the results of the performance. Consultant shall not represent that Consultant or its agents, employees or independent contractors are agents or employees of the City. Except as the City may specify in writing, Consultant shall have no authority, express or implied, to act on behalf of the City in any Capacity whatsoever as an agent. Consultant shall have no authority, express or implied, pursuant to this Agreement, to bind the City to any obligation whatsoever. 7. Accounting Records. The Consultant agrees to maintain all records and other evidence pertaining to cost incurred and work performed hereunder, and shall make them available at the Consultant's office during the Agreement period and thereafter for period of three years from the date of receipt of final payment. 8. Ownership of Data. All data, maps, photographs, scanned documents, and other material collected or prepared under the Agreement shall become the property of the City. 9. Termination. City may terminate this Agreement at any time for any reason upon fourteen (14) days written notice to the Consultant. Upon receipt of such notice and if requested to do so by the City, Consultant shall stop work at the stage directed by City and shall deliver all transmitted documents to the City. Consultant shall accept as full payment for services rendered to the date of termination a pro rata share of the total Agreement payment based on the portion of work actually performed. 10. Amendment. It is mutually understood and agreed that no alteration or variation of the terms of this Agreement, or any subcontract requiring the approval of the City shall be valid unless made in writing, signed by the parties hereto. 11. Non — Solicitation Clause. The Consultant warrants that he /she has not employed or retained any company or persons, other that a bona fide employees working solely for the consultant, or paid any fee, commission, percentage, brokerage fee, gifts or any other consideration, contingent upon or resulting from the award or making of this Agreement. For breach or violation of this warranty, the City Shall have the right to annul this Agreement without liability, or, in its discretion to deduct from the Agreement price or consideration, or otherwise recover, the full amount of such fee, commission, percentage, brokerage free, gift, or contingent fee. 12. Indemnification. Consultant shall indemnify, defend, and hold harmless the City and its officers, officials, agents, employees and volunteers against any and all liability, claims, actions, causes Page 2 of 9 of action or demands whatsoever against any of them, including an injury death of any persons or damage to property or other liability of any nature, to the extent arising out of or in any way connected with the negligent performance of this Agreement. 13. Insurance. Consultant shall procure and maintain at its sole cost for the duration of this Agreement the following insurance: (a) Minimum Scope of Insurance. Coverage shall be at least as broad as: (1) Insurance Services Office Commercial General Liability coverage ( "occurrence" form CG 0001). (2) Insurance Services Office form number CA 0001 covering Automobile Liability, code 1 (any auto). (3) Workers' Compensation insurance as required by the Labor Code of the State of California and Employers Liability insurance (4) Errors and Omissions liability insurance appropriate to Consultant's profession. (b) Minimum Limits of Insurance. Consultant shall maintain policy limits of no less than: (1) General Liability: $1,000,000 combined single limit per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project /location or the general aggregate limit shall be twice the required occurrence limit. (2) Automobile Liability: $1,000,000 combined single limit per accident for bodily injury and property damage. (3) Worker's Compensation and Employers Liability: Worker's Compensation limits as required by the Labor Code and Employers Liability limits of $1,000,000 per accident. (4) Errors and Omissions Liability: $1,000,000 per claim and annual aggregate (c) Deductibles and Self-Insured Retention. Any deductibles or self insured retention must be declared to and approved by the City. At the option of the City, either: the insurer shall reduce or eliminate such deductibles or self - insured retention as respects the City, its officer, officials, employees and volunteers; or Consultant shall procure a bond guaranteeing payment of losses and related investigation, claim administration and defense expenses. (d) Other Insurance Provisions. The policies shall contain, or be endorsed to contain, the following provisions: (1) General Liability and Automobile Liability Coverage. a. The City, its officers, officials, employees, agents and volunteers are to be covered as insured as respects: liability arising out of activities performed by or on Page 3 of 9 behalf of Consultant; products and completed operations of Consultant; premises owned, occupied or used by Consultant; or automobiles hired or borrowed by Consultant. The coverage shall contain no special limitations on the scope of protection afforded to the City, its officers, officials, employees, agents or volunteers. b. Consultant's insurance coverage shall be primary insurance as respects the City, its officers, officials, employees and volunteers. Any insurance or self - insurance maintained by the City, its officers, officials, employees and volunteers. Any insurance or self - insurance maintained by the City, its officers, officials, employees, agents or volunteers shall be excess of Consultant's insurance and shall not contribute with it. c. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its officers, officials, employees, agents or volunteers. d. Consultant's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. (2) Worker's Compensation and Employers Liability Coverage. The insurer shall agree to waive all rights of subrogation against the City, its officer, officials, employees and volunteers for losses arising from work pe- formed by Consultant for the City. (3) All Coverage. Each insurance policy required by this clause shall be endorsed to state that coverage shall not be canceled by either party except after thirty (3) days' prior written notice by mail has been given to the city. (e) Acceptability of Insurers. Insurance s to be placed with insurers with a Best's rating of no less than A:VII (f) Verification of Coverage. Consultanr. shall furnish the City with certificates of insurance and with original endorsements effecting coverage required by thissection. The certificates and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. All certificates and endorsements are to be received and approved by the City before work commences. The City reserves the right to require complete certified copies of all required insurance policies, at any time. 14. Safety and Accidents. Consultant shall comply with all laws and industrial safety standards. If a death, serious personal injury or substantial property damage occurs in connection with the performance of this Agreement, Consultant shall immediately notify the City's Risk Manager by telephone. 15. Ownership of Documents. All documents of any type developed or obtained by Consultant in the performance of this Agreement shall be deemed to be the property of the City Page 4 of 9 16. Notice. Any notice to be given under this Agreement shall be given by enclosing the same in a sealed envelope, first -class postage prepaid and depositing the same in the United States mail, addressed to the party at the following address: CITY: City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Attention: CONSULTANT: CSG Consultants, Inc. 1700 S. Amphlett Blvd. 3 Floor San Mateo, CA 94402 17. Assignment. This Agreement contemplates the personal services of Consultant and its employees and it is understood by both parties that a substantial inducement to City for entering into this Agreement was, and is, the professional reputation and competence of Consultant. Consultant shall not assign or otherwise transfer this Agreement or the rights or obligations hereunder without the prior written consent of the City. 18. Qualifications. Consultant represents that it and its employees are fully qualified to perform the services under this Agreement. Consultant represents and warrants to the City that Consultant has, and at all times during the performance of this Agreement shall maintain all licenses, permits, qualifications and approvals of any nature which are required for Consultant to practice Consultant's profession. 19. Time of Performance. The time of performance of the services under this Agreement is important to the City, and all time deadlines indentified in the Project Schedule shall be strictly construed. 20. Standard of Performance. Consultant shall perform all services required pursuant to this Agreement in the manner and according to the standards observed by a competent practitioner of the profession in which Consultant is engaged in the geographical area in which Consultant practices his profession. All products which Consultant delivers to City pursuant to this Agreement shall be prepared in a substantial, workmanlike manner, and conform to the standards of quality normally observed by a person practicing in Consultant's profession. The City shall be the sole judge as to whether the product of the Consultant is satisfactory. 21. Prohibited Interest. No officer or employee of the City shall have any direct financial interest in this Agreement. This Agreement shall be voidable at the option of the City if this provision is violated. 22. Governing Law. California law shall govern this Agreement. Any action to enforce or interpret this Agreement shall be brought in a court of competent jurisdiction in Santa Clara County, California. Page 5 of 9 23. Entire Agreement. This Agreement is the entire Agreement between the parties and supersedes all prior negotiations, representations, or agreements, whether written or oral. This Agreement may be amended only by written agreeme -lt signed by both parties. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the i' day of I , 2011. CONSULTANT CITY OF CUPERTINO By: B'y: �'LI /W Print: i G.' /S l/a/l; r''C(: i� ` ' C. P15 Print: " Albert Salvador Title: Pa % 6 Jr Title: Building Official Tax ID: 6 7 / 2 3 / ? APPROVALS EXPENDITURE DISTRIBUTION DEPARTMENT HEAD SIGN ATURE DATE /efe' e h/ Aarti Shrivastava Account Number: CITY CLERK SIGNA URE DATE 1 10- 7507014 b /as // Kimberl Smith Page 6 of 9 EXHIBIT A SCOPE OF SERVICES BUILDING PLAN CHECK CSG's professional engineers are ready to assist in all aspects of plan review. We promise prompt turnaround times and offer online paperless submittal and plan review. CSG reviews building construction and /or development plans for residential (single and multiple family dwellings), commercial, and industrial buildings for compliance with all policy and model codes and municipal codes adopted by the City and County, including but not limited to: • 2010 California Building (Volumes 1 and 2), Electrical, Plumbing, Mechanical, Fire, Residential, Energy, and Green Building Standards Code as adopted by the State of California. • City adopted ordinances and amendments relative to building and municipal codes, including project Conditions of Approval from other City departments, divisions, regulating agencies and jurisdictions. • Energy Standards as specified in Title -24 of the State Building Codes, and FEMA flood zone regulations. • Non - structural plan check will conform with regulations contained in the most current City - adopted Building, Plumbing, Mechanical and Electrical Codes (as amended by the City of Cupertino), as well as State laws governing building and development construction and FEMA flood zone regulations. • Structural plan check will conform with regulations contained in the most current City- adopted Building Code, Uniform Code for Building Conservation, State of California Historic Building Code (as amended by the City of Cupertino), associated structural FEMA flood zone regulations and State laws governing buildings and development. Project Time Line We consistently achieve quality plan check while maintaining reliable turnaround times. We perform off -site plan check services within the following time lines *: Project Type Initial Review Re -check Single Family Dwellings / Additions / Remodels 10 5 Tenant Improvements / Commercial / Industrial Projects 10 5 Single Family Subdivisions 10 5 Multi- Family Apartments, 10 5 Condominiums 10 5 Complex Commercial Projects 15 5 While CSG welcomes complex projects, turnaround time may vary. Extraordinarily complex projects may require additional time and will immediately be brought to the attention of the city's designated representative. * Please note that turnaround times are based upon the date we receive the plan, not the date it is submitted to the City. Plan Check Comments All plan check comments are formatted to the city's established correction list templates. Any additional forms established by the city for alternative methods of construction and /or deviations from requirements, such as disabled access, will be incorporated into the correction comments and returned completed with the appropriate recommendations. In addition, Internet access is available for transferring plan check comments. This will enable city staff to immediately modify CSG's checklist for incorporation with other department comments. Page 7 of 9 Accelerated Plan Check CSG completes initial accelerated plan check in fewer than five working days. Rechecks are completed in less time. At your request, we can perform plan check services within an accelerated time frame; negotiated on behalf of the applicant, the City of Cupertino and CSG. Accelerated plan check requires an additional fee to be agreed upon by the applicant and CSG. Our fee to the city will remain unchanged. Online Plan Check Status CSG offers a convenient service that allows clients to check plan review status and comments online. By logging on to our website, clicking on Plan Check Status, and entering a password, staff, as well as authorized applicants, can view each project document and communicate with the plan checker via e- mail or post -a -note. With a password, staff or authorized applicants can download comments from the web upon completion of the plan review. There is no additional cost for this service. Building Inspection Services Our certified bilingual inspectors offer integrated building inspection services. We can work on a full or part -time basis, whatever the need and budget. We perform building and fire inspections for residential, commercial and industrial projects, and are experienced in all construction types. Our certified inspectors ensure compliance with applicable codes and requirements by identifying code violations, educating property owners and tenants on potential risks and safety hazards, and by working as a team to correct violations. Digital Scanning and Archiving Services CSG can provide digital scanning and archival services of existing paper plans into widely accepted PDF digital formats using our GreenVue.dox module. Conversion of existing microfiche or microfilm archived media is also available. GreenVue.dox is a complete solution for searching, viewing, and printing digitally scanned documents. Designed to utilize minimal system resources, GreenVue.dox will run on virtually any Windows based workstation. Our standard file type for scanning is PDF, a widely accepted storage format. Media converted to digital format is preserved on a minimum of two sets of DVI) -R media. A live copy stored on a hard drive media is kept as well. We provide the City with copies of the DVD -R media as well as a live copy to be kept as part of the On -site GreenVue.dox storage system. As a final client safety net, copies of all archived files are also kept at the offices of CSG Consultants. Average turnaround time for archival scanning is one week or better for paper or vellum media in good condition; turnaround times for damaged or poor condition paper or vellum media may be longer. Average turnaround time for archival scanning is one month or better for film media Proposed updates for GreenVue.dox On -site archives at the City are once per quarter Turnaround time for a high volume /large batch of documents may be longer Each image is checked for completeness of the scan. All original physical media is hand checked and individually prepared for scanning. Special care will be taken for older or fragile media as required Address and APN information is checked against databases provided by the County Assessor's Office. Page 8 of 9 EXHIBIT B COST PROPOSAL SERVICE CONSULTANT FEE Building Plan Review 65% of City's Plan Review Fee. Plan review includes up to three (3) resubmittals. Structural Plan Review Only 5105 per hour Accelerated / Expedited Plan Review 90% of City's Plan Review Fee ($200.00 minimum) Plan review fees assessed upon submission of plans. Building Inspection $85 per hour Scanning & Archiving $0.10 per page (smaller than 1 x 1 7) $1.25 per page (11 x 17 and larger) Includes indexing all scans by two fields (ie, address and project number) Additional $1.50 per PDF file to index an additional seven fields (total nine fields) All costs quoted above include a project manager and required project support staff. GreenVue.dox Software One time set up fee of $1,000 The City will need to provide the server for the system. Recommended server requirements are: • Windows Server 2000 or higher • 1 GB memory • MS -SQL Server (Standard is preferred, Express can be used) • Local Administrator level access for OS and SA level access for SQL instance • 1000B free hard drive space (less initial space may be allocated in a Virtualized environment if the drive can be dynamically resized) • One file share accessible to all City users (this is where the scans will be located) • Remote access for CSG staff to configure /administer the system • For ease, a Virtualized platform is encouraged Page 9 of 9 Form W Request for Taxpayer Give form to the (Rev. October 2007) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service Name (asken n yoyr income tax return) , oi L DC1 (_ % \` i � S if 1 C s m Business name, if different from above a C 0 m G Check appropriate box: ❑ Individual /Sole proprietor Corporation CI Partnership Exempt El Limited liability company. Enter the tax classification (D= disregarded antity, C= corporation, P= partnership) Ix. 1 ---I payee `a :4 11 Other (see instructions) ► c c Address (number, street, and apt. or suite no.) ,_I Requester's name and address (optional) E City, state, v anq ZIP code . f , �_ • 33 List account number(s) here (optional) U) Part 1 Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid social security number backup withholding. For individuals, this is your social security number (SSN). However, for a resident , alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number number to enter. 64 ( , 30 j 'j z I Part 11 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and divicends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4. Sign Signature of 1 'I '� _ , '/� . C3 Here U.S. person I. ` Date ► ce 7 General Instructions Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: Section references are to the Internal Revenue Code unless • An individual who is a U.S. citizen or U.S. resident alien, otherwise noted. • A partnership, corporation, company, or association created or Purpose of Form organized in the United States or under the laws of the United A person who is required to file an information return with the States, IRS must obtain your correct taxpayer identification number (TIN) • An estate (other than a foreign estate), or to report, for example, income paid to you, real estate • A domestic trust (as defined in Regulations section transactions, mortgage interest you paid, acquisition or 301.7701 -7). abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a contributions you made to an IRA. trade or business in the United States are generally required to Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W -9 requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a that you are not subject to backup withholding, or partnership conducting a trade or business in the United States, 2. Certify Y subject g. provide Form W -9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable, you are also certifying that as a income. U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding foreign partners' share of effectively connected income. on its allocable share of net income from the partnership Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if it is following cases: substantially similar to this Form W -9. • The U.S. owner of a disregarded entity and not the entity, Cat. No. 10231X Form W-9 (Rev. 10 -2007) --.. OP ID: AE '4 I DATE (MM /DDIYYYY) � ° D CERTIFICATE OF LIABILITY INSURANCE 04/11/11 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 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). PRODUCER 925- 462 -2111 NAME: CONTACT Jeanne Winter Pleasanton Valley Insurance - -2113 PHONE g25- 462 -2111 FAX 925 462 Lic #0B07066 _(A/C No ExO: (NC, No): 925- 462 -2113 6602 Owens Drive, Suite 200 E -MAIL eanne vi rou ADDRESS: @P 9 P• com Pleasanton, CA 94588 PRODUCER CSGCO - Wayne Rudick CUSTOMER ID it INSURER(S) AFFORDING COVERAGE NAIC a INSURED CSG Consultants Inc. INSURER A: Travelers Property & Casualty 1700 South Am phlett Blvd 3rdFL INSURER B :ACE USA San Mateo, CA 94402 INSURER C: Hartford Fire Ins. Co. INSURER D : Axis Surplus Insurance • INSURER E: r 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE [NCR Wvn POLICY NUMBER IMM /nnIYYYYI IMMInnIYYYYI GENERAL LIABILITY • EACH OCCURRENCE $ 2,000,000 AMAGE TED A X COMMERCIAL GENERAL LIABILITY X 680-294M0850 12/04/10 12/04/11 PREMISES (TO Ea REN occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 B X E &O EONG21680072006 12/04/10 12/04/11 PERSONAL & ADV INJURY $ 2,000,000 B X $0 SIR EONG21680072006 12/04/10 12/04/11 GENERAL AGGREGATE $ 4,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 4,000,000 POLICY PRO X LOC E &O $ $3M /$5M AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO BA-461M7612 12/04/10 12/04/11 (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE A X HIRED AUTOS BA-461M7612 12/04/10 12/04/11 (Per accident) $ A X NON -OWNED AUTOS BA -461 M7612 12/04/10 12/04/11 $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 3,000,000 CUP- 294M1060 12/04/10 12/04/11 A DEDUCTIBLE Following $ X RETENTION $ Form $ WORKERS COMPENSATION x WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS E C ANY PROPRIETOR /PARTNER /EXECUTIVE Y 1 - 7 51 WE LS2852 12/04/10 12/04/11 E.L. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Tech E &0 ECN000010291001 12/04/10 12/04/11 Ea Act 1,000,00C Claims -Made RETRO -DATE 12/4/04 Retention 15,00C DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City, its officers, officials, employees, agents and volunteers are Additional Insured; GL primary insurance applies per attached endorsements. CERTIFICATE HOLDER CANCELLATION CITYCUP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10300 Torre Avene Cupertino, CA 95014 • AUTHORIZED REPRESENTATIVE ca a A61/ , µ © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the hollowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): ALL LOCATIONS OWNED OR OCCUPIED BY THE INSURED (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes legally the General Aggregate Limit shown in the obligated to pay as damages caused by "occur- Declarations nor shall they reduce any other rences" under COVERAGE A (SECTION I), and Designated Location General Aggregate Limit for all medical expenses caused by accidents un- for any other designated "location" shown in der COVERAGE C (SECTION I), which can be the Schedule above. attributed only to operations at a single desig- 4. The limits shown in the Declarations for Each nated "location" shown in the Schedule above: Occurrence, Damage To Premises Rented To 1. A separate Designated Location General Ag- You and Medical Expense continue to apply. gregate Limit applies to each designated "lo- However, instead of being subject to the cation ", and that limit is equal to the amount General Aggregate Limit shown in the Decla- of the General Aggregate Limit shown in the rations, such limits will be subject to the ap- Declarations. plicable Designated Project General Aggre- 2. The Designated Location General Aggregate gate Limit. Limit is the most we will pay for the sum of all B. For all sums which the insured becomes legally damages under COVERAGE A, except dam- obligated to pay as damages caused by "occur - ages because of "bodily injury" or "property rences" under COVERAGE A (SECTION I), and damage" included in the "products- completed for all medical expenses caused by accidents un- operations hazard ", and for medical expenses der COVERAGE C (SECTION I), which cannot be under COVERAGE C regardless of the num- attributed only to operations at a single desig- ber of: nated "location" shown in the Schedule above: a. Insureds; 1. Any payments made under COVERAGE A for b. Claims made or "suits" brought; or damages or under COVERAGE C for medical expenses shall reduce the amount available c. Persons or organizations making claims under the General Aggregate Limit or the or bringing "suits ". Products - Completed Operations Aggregate 3. Any payments made under COVERAGE A for Limit, whichever is applicable; and damages or under COVERAGE C for medical 2. Such payments shall not reduce any Desig- expenses shall reduce the Designated Project nated Project General Aggregate Limit. General Aggregate Limit for that designated "location ". Such payments shall not reduce C. When coverage for liability arising out of the "products- completed operations hazard" is pro - CG D3 15 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. COMMERCIAL GENERAL LIABILITY vided, any payments for damages because of "Location" means premises involving the same or "bodily injury" or "property damage" included in connecting lots, or premises whose connection is the "products- completed operations hazard" will interrupted only by a street. roadway, waterway or reduce the Products - Completed Operations Ag- right -of -way of a railroad. gregate Limit, and not reduce the General Aggre- E. The provisions of Limits of Insurance (SECTION gate Limit nor the Designated Project General III) not otherwise modified by this endorsement Aggregate Limit. shall continue to apply as stipulated. D. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: Page 2 of 2 Copyright, The Travelers Indemnity Company, 2003 CG D3 15 11 03 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CSG Consultants, Inc. Policy #680- 294M0850 12/4/10 to 1214!11 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The "personal injury" or "advertising injury" for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However, if you specifically agree in a written con- cess Insurance regarding any other primary in tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non - contributory basis, this insur- Subparagraph (1): ance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy, including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE: • CUPERTINO, CA 95014 -3255 y -C. i9 s s TELEPHONE: (408) 777 -3223 • FAX: (408) 777 -3366 CUPERTINO WEBSITE: www.cupertilo.org April 26, 2011 CSG Consultants, Inc. Attn: Cyrus Iszanpour 1700 S. Amphlett Blvd. 3rd Floor San Mateo, CA 94402 Re: Consultant Services Agreement A fully executed copy of your agreement with the City of Cupertino is enclosed. If you have any questions or need additional information, please contact the Building Department at (408) 777- 3228. Sincerely, Kirsten Squarcia City Clerk's Office Enclosure cc: Building P52(")2MX)2 / 7 ® DATE(MMIDDIYYYY) A�° CERTIFICATE OF LIABILITY INSURANCE 09/16/2013 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. p IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must 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). PRODUCER 0726293 1-415-546-9300 CONTACT Don Tarantino NAME: Arthur J. Gallagher & Co. PHONE FAX Insurance Brokers of California, Inc., License #0726293 ]Extl: 415-536-8617 AIC No: 415-536-8627 > 1255 Battery Street #450 ADDRESS: don-tarant lnoLaaj g.com w San Francisco, CA 94111 ____ INSURER(S)AFFORDING COVERAGE _ NAICX INSURER A_: TRAVELIM PROP CAS CO OF AbM 25674 INSURED INSURER B: TWIN CITY FIRE INS CO CO 29459 CSG Consultants Inc. ARCH INS CO 11150 Precision Inspection - CSG INSURERC: 1700 S. Amphlett Blvd 3rd Floor INSURER D: San Mateo, CA 94402 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 35724034 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. INS R TYPE OF INSURANCE ADOI UBR POLICY NUMBER IIMILDICY EFF MPLpp LIMITS LTR A GENERAL LIABILITY X 680294MOS50-TIL-12 1.2/04/1 12/04/13 EACH OCCURRENCE $1,000,000 X_ DAMAGE TO COMMERCIAL GENERAL LIABILITY PREMISES(Ea aEoccurrence $1,000,000 CLAIMS-MADE lxl OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- X LOC S JECT A AUTOMOBILE LIABILITY X BA-46IM7612-12 COMBINED SINGLE LIMIT 1,000,00 0 L accident— _$_-1, __---- X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) f AUTOS AUTOS -- - NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR CUP294M1060-12 12/04/1 12/04/13 EACH OCCURRENCE $5,000,000 EXCESS LLAB _ CLAIMS-MADE AGGREGATE _ $5,000,000 DED RETENTION _ Following Form f B WORKERS COMPENSATION X 57WREP4360-01 12/04/1 12/04/13 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE F-] NIA E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 _ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Prof Liability ARP 004731501 12/04/1 12/04/13 Limit: 3Mil/3Mil Retention 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) City, its City Council, boards and commissions, officers, employees and volunteers are named as additional insured as respects General, Auto, and Umbrella Liability policy(ies), pursuant to and subject to the policy-s terms, definitions, conditions and exclusions. Waiver of Subrogation applies to additional insureds, as respects General, Auto Liability policy(s), pursuant to and subject to the policy-s terms, definitions, conditions and exclusions. CERTIFICATE HOLDER CANCE--LLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Roger Lee 10300 Torre Ave. AUTHORIZED REPRESENTATIVE Cupertino CA 95014 _� USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD jabezean 35724034 P526IN12%IM12 00 Wl 0 COMMERCIAL GENERAL LIABILITY N POLICY NUMBER: 680-294MO850-TIL-12 ISSUE DATE: 10-25-12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. z ADDITIONAL INSURED W (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S)OR ORGANIZATION(S): PER SCHEDULE ON FILE WITH AGENT PROJECT/LOCATION OF COVERED OPERATIONS: PROVISIONS A. The following is added to WHO IS AN INSURED The insurance provided to such additional insured (Section II): is limited as follows: The person or organization shown in the Sched- d. This insurance does not apply to the render- ule above is an additional insured on this Cover- ing of or failure to render any "professional age Part,but only with respect to liability for"bod- services". ily injury", "property damage" or"personal injury" e. The limits of insurance afforded to the addi- caused, in whole or in part, by your acts or omis- tional insured shall be the limits which you sions or the acts or omissions of those acting on agreed in that"contract or agreement requir- your behalf: ing insurance" to provide for that additional a. In the performance of your ongoing opera- insured, or the limits shown in the Declara- tions; tions for this Coverage Part, whichever are b. In connection with premises owned by or less. This endorsement does not increase the rented to you;or limits of insurance stated in the LIMITS OF c. In connection with "your work" and included INSURANCE (Section III) for this Coverage Part. within the "products-completed operations hazard". B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL Such person or organization does not qualify as LIABILITY CONDITIONS(Section IV): an additional insured for"bodily injury", "property damage" or "personal injury" for which that per- However, if you specifically agree in a'contract or son or organization has assumed liability in a con- agreement requiring insurance"that,for the addi- tract or agreement. tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 ©2007 The Travelers Companies,Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission P5261M12%""2 LL. 00 G. 0 COMMERCIAL GENERAL LIABILITY M Coverage Part must apply on a primary basis, or injury"arising out of"your work"on or for the pro- a primary and non-contributory basis, this insur- ject, or at the location, shown in the Schedule z ance is primary to other insurance that is avail- above, performed by you, or on your behalf, un- able to such additional insured which covers such der a"contract or agreement requiring insurance" additional insured as a named insured, and we with that additional insured. We waive these will not share with the other insurance, provided rights only where you have agreed to do so as that: part of the"contract or agreement requiring insur- (1) The "bodily injury" or "property damage" for ance"with that additional insured entered into by which coverage is sought occurs;and you before, and in effect when, the"bodily injury" or"property damage"occurs, or the "personal in- (2) The "personal injury" for which coverage is jury"offense is committed. sought arises out of an offense committed; D. The following definition is added to DEFINITIONS after you have entered into that "contract or (Section V): agreement requiring insurance" for such addi- tional insured. But this insurance still is excess "Contract or agreement requiring insurance" over valid and collectible other insurance, means that part of any contract or agreement un- whether primary, excess, contingent or on any der which you are required to include the person other basis, that is available to the additional in- or organization shown in the Schedule as an ad- _ ditional insured on this Coverage Part, provided sured when the additional insured is also an addi- tional insured under any other insurance. that the"bodily injury"and"property damage"oc- curs, and the"personal injury"is caused by an of- C. The following is added to Paragraph 8. Transfer fense committed: Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- a. After you have entered into that contract or DITIONS(Section IV): agreement; We waive any rights of recovery we may have b. While that part of the contract or agreement is against the additional insured shown in the in effect;and Schedule above because of payments we make c. Before the end of the policy period. for"bodily injury", "property damage"or"personal Page 2 of 2 ©2007 The Travelers Companies,Inc. CG D3 82 09 07 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission P5261K12%1X12 00 COMMERCIAL GENERAL LIABILITY M THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS z w This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal Injury"or"advertlsing Injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage Is sought arises out of an of- (Section IV), Paragraph 4. (Other insurance), Is fense committed amended as follows: subsequent to the signing and execution of that 1. The following In added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However,If you specifically agree In a written con- cess Insurance regarding any other primary In- tract or written agreement that the Insurance pro- surance available to you Is deleted. vlded to an additional Insured under this 3. The following Is added to Paragraph b. Exceae Coverage Part must apply on a primary basis,or Insurance, as an additional subparagraph under a primary and non-contributory basis, this Insur- Subparagraph(1); ance Is primary to other Insurance that Is avail- able to such additional Insured which covers such That is available to the Insured when the Insured additional Insured as a named Insured, and we Is added as an additional umbrella or under any other will not share with that other Insurance, provided Policy,Including any umbrella or excess policy, that: a. The 'bodily Injury" or "property damage"for which coverage Is sought occurs;and CG DO 37 04 05 Copyright 2005 The St.Paul Travelers Companies, Inc.All rights reserved, Page 1 of 1 P526IM1281X12 k 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION BROAD FORM ENDORSEMENT W EXTENDED OPTIONS P licy Numbw: 57 WE EP4360 Endorsement Number: r` `M Eflectiv Date: 12/04/12 Effective hour Is the same as stated on the Information Page of the policy. C) Nam d Insured and Address: CSG CONSULTANTS INC 0 1700 S AMPHLETT BLVD 3RD FL o SAN MATED, CA 94402 0 5o P4 Section I of this endorsement expands coverage provided under WC 00 00 00. w Section II of this endorsement provides additional coverage usually,only provided by endorsement. Ln c Section III of this endorsement is a Schedule of Covered States. C1 You may use the Index to locate these coverage features quickly: r4 NEX SUBJECT EME ;:!!@dm PADE 2 B. Part One Does Not Apply 3 � SECTION I PARTS ONE and TWO 2 C. Application of Coverage Ot We Will Also Pay 2 D. Additional Exclusions 3 s� PART-THREE 2 E. West Virginia 3 02 How This Insurance Works 2 EXTENDED OPTIONS 4 ■aze PART-80( 2 01 Employers'Uabll ty Insurance 4 03 Transfer of Your Rights and Duties 2 02 Unintentional Failure to Disclose 4 Vale 04 Liberalization 2 Hazards I� SECTION M 2 03 Waiver of Our Right to Recover from 4 VOLUNTARY COMPENSATION INSURANCE 2 mere 05 Voluntary Compensation Insurance 04 Foreign Voluntary Compensation 4 A. How This Insurance Applies 2 A. How This Reimbursement Applies 4 B. We Will Pay 2 B. We Will Reimburse 4 C. Exclusions 3 C. Exclusions 4 D. Before We Pay 3 D. Before We Pay 5 E. Recovery From Others 3 E. Recovery From Others 5 F. Employers'Liability Insurance 3 F. Reimbursement For Actual Loss 5 EMPLOYERS'LIABILITY STOP"P 3 Sustained ENDORSEMENT 3 G. Repatriation 5 06 Employers'Uablliry H. Endemic Disease 5 Stop Gap 3 05 Longshors and Harbor Workers' S Coverage Compensation Act Coverage A. Stop Gap Coverage Limited to 3 Endorsement Montana,North Dakota,Ohio, SECTION III 6 Washington,West Virginia and Wyoming 01 Schedule of Covered States 6 Form WC 99 03 03 B Printed In U.S.A.(Ed.11100) Ppe I Of 0 Process Dat : 10/09/12 Policy Expkation Oats: 12104/13 2000,The HaWord GQ 00 SECTION 1 0 PARTS ONE and TWO PART THREE 1. WE WILL ALSO PAY 2. How This Insurance Applies D. W Will Also Pay of Part One (WORKERS' Paragraph 4.of A. How This Insurarc Appli a COMPENSATION INSURANCE);and of Part 3 (Other States Insurance)is replaced by w E. We Will Also Pay of Pat Two(EMPLOYERS' the following: LIABILITY INSURANCE) Is replaced by the 4. If you have work on the effective date of this following: policy in any state not listed In Item 3.A.of the We Will Also Pay Information Page, coverage will not be afforded for that state unless we are notified We will also pay these costs, in addition to within sixty days. other amounts payable under this Insurance, as part of any claim, proceeding, or suit we PARTSIX defend: 1. reasonable expenses incurred at our 3. Transfer Of Your Rights and Duties request,I ICLt1DING loss of earnings; C. Transfer Of Your Rights and Duties of Part 6 (Conditions)is replaced by the following: 2. premiums for bonds to release Your rights or duties under this policy may not attachments and for appeal bonds in bond be transferred without our written consent. amounts up to the limit of our liability under this Insurance; If you die and we receive notice within sixty _ 3. litigation costs taxed against you; days after your death,we will cover your legal 4. interest on a judgment representative as insured. j gment as required by law until we offer the amount due under this 4. Liberalization law;and If we adopt a change in this form that would 5. expenses we incur. broaden the coverage of this form without extra charge, the broader coverage will apply to this policy. it will apply when the change becomes effective in your state. SECTION 11 VOLUNTARY COMPENSATION AND EMPLOYERS' 3. The bodily Injury must occur in the United LIABILITY COVERAGE States of America, its territories or S. Voluntary Compensation Insurance possessions, or Canada, and may occur elsewhere If the employee is a United A. H w Thls Insurance Applies States or Canadian citizen. or otherwise This insurance applies to bodily injury by legal resident,and legally employed,in the accident or bodily Injury by disease. Bodily United States or Canada and temporarily Injury Includes resulting death. away from those places. 1. The bodily injury must be sustained by any 4. Bodily Injury by accident must occur officer or employee not subject to the during the policy period. workers' compensation law of any state 5. Bodily injury by disease'must be caused shown in Item 3.A. of the Information or aggravated by the conditions of the Page. 2. The bodily Injury must arise out of and in the course of employment or Incidental to work In a state shown in Item 3.A. of the Information Page. Form WC 99 03 03 6 Printed in U.S.A.(Ed.tlW) Page 2 116 PNAAQWKQ u. 00 officers or employee's employment. The If the persons entitled to the benefits of this 0 officers or employee's last day of last Insurance make a recovery from others, they exposure to the conditions causing or must reimburse us for the benefits we paid aggravating such bodily injury by disease them. must occur during the policy period. IF. Employers'Liability Insurance v B. W WIN pay Part Two (Employers' Liability Insurance) > w We will pay an amount equal to the benefits applies to bodily Injury covered by this that would be required of you as ff you and endorsement as though the State of your employees were subject to the workers' Employment was shown In Item 3.A. of the compensation law of any state shown in Item Information Page. 3.A. of the Information Page. We WIN pay This provision 5. does not apply In New Jersey or rr- those amounts to the persons who would be Wisc*nsin. M entitled to them under the law. EhIPLOYERS'LIABILITY STOP GAP COVERAGE 0 C. Exalu" 9. Employers'Liabllity Stop Gap COVSng c This insurance does not cover. A. This coverage only applies In Montana, North 0 1. any obligation imposed by workers' Dakota, Ohio, Washington,West Virginia and 0 compensation or occupational disease law Wyoming. rn or any similar law. B. Part One (Workers' Compensation Insurance) w 2. bodily Injury Intentionally caused or does not apply 10 work In states shown in r aggravated by you. Paragraph A above. 0 3. officers or employees who have elected C. Part Two (Employers' Liability Insurance) °n not to be subject to the state workers' applies in the states,shown in Paragraph A., « compensation law. as though they were shown in Item 3.A.of the C 4. partners or sole proprietors not covered Information Page. under the Standard Sole Proprietors, D. Part Two, Section C. Exclusions is changed Partners, Officers and Others Coverage by adding these exclusions. ® Endorsement. This insurance does not cover, ram D. Before We Pay 6. bodily injury intentionally caused or Before we pay benefits to the persons entitled aggravated by you or in Ohio bodily injury to them,they must: resulting from an act which is determined � 1. Release you and us, In writing, of aN by an Ohio court of law to have been ® responsibility for the Injury or death. committed by you with the belief than an 0 injury Is substantially certain to occur. 2. Transfer to us their right to recover from tf= However, the cost of defending such others who may be responsible for the � claims or suits in Ohio is covered. Injury or death. ONCE 3. Cooperate with us and do everything 13. bodily Injury sustained by any member of necessary to enable us to enforce the right the flying crew of any aircraft. to recover from others. 14. any claim for bodily injury with respect to If the persons entitled to the benefits of this which you are deprived of any defense or insurance fail to do those things, our duly to defenses or are otherwise subject to >� penalty because of default in premium tee pay ends at once. If they claim damages from under the provisions of the workers' you or from us for the injury or death,our duty compensation law or laws of a state to pay ends at once, shown In Paragraph A. ttfs� E. Recovery From Others E. This insurance applies to damages for which It we make a recovery from others, we will you are liable under West Virginia Code Annot. keep an amount equal to our expenses of S23-4-2. recovery and the benefits we paid. We will i! pay the balance to the persons entitled to ft. Form WC 99 03 03 B Printed in U.S.A. (Ed.9100) Pape 3 of 6 P52W)2VAX)2 IIIIII- 00 LL EXTENDED OPTIONS 1. Empl yore'Llabilily Insurance 4. Foreign Voluntary Compensation and Rom S.B.of the Information Paps Is replaced by Employers'LlaWlity Reimbursement the following: A. How This Reimbursement Applies B. Employers'Liability Insurance: This reimbursement provision applies to bodily 1. Part Two of the policy applies to work in injury by accident or bodily injury by disease. each state listed In Item 3.A. Bodily injury Includes resulting death. 1. The bodily Injury must be sustained by an The Limits of Liability under Part Two are officer or employee. the higher of: 2. The bodily injury must occur in the course of employment necessary or incidental to Bodily Injury work in a country not listed In Exclusion by Accident $500,000 Each Accident CA.of this provision. 3. Bodily Injury by accident must occur Bodily Injury during the policy period. by Disease $600,000 Policy Limit 4. Bodily Injury by disease must be caused or aggravated by the conditions of your Bodily Injury employment. The officer or employee's by Disease $600,000 Each Employee last exposure to those conditions of your employment must occur during the policy OR period. B. We Will Reimburse 2. The amount shown In the Information We will reimburse you for all amounts paid by Page. you whether such amounts are: This provision 1 of EXTENDED OPTIONS does not 1. voluntary payments for the benefits that apply in New York because the Limits Of Our would be required of you M you and your Liability are unlimited. officers or employees were subject to any In this provision the limits are changed from workers'compensation law of the state of $600,000 to$1„000,000 in California. hire of the individual employee. 2. Untnt ntional Failure to Disclose Hazards 2. sums to which Part Two (Employers' If you unintentionally should fail to disclose all Liability Insurance) would apply if the existing hazards at the Inception date of your Country of Employment were shown In policy, we shall not deny coverage under this Item 3.A.of the Information Page. policy because of such failure. C. Exclusions S. Waiver of Our Right To Recover From Others This insurance does not cover. A. We have the right to recover our payments 1. any occurrences In the United States, from anyone liable for an Injury covered by this Canada, and any country or jurisdiction policy. We will not enforce our right against which Is the subject of trade or economic any person or organization for whom you sanctions Imposed by the laws or perform work under a written contract that regulations of the United States of requires you to obtain this agreement from us. America in effect as of the Inception date This agreement shall not operate directly or of this policy. Indirectly to benefit anyone not named In the 2. any obligation imposed by a workers' agreement. compensation or occupational disease B. This provision 3. does not s law,or similar law. p apply In the states of Pennsylvania and Utah. 3. bodily injury Intentionally caused or aggravated by you. Form WC 09 03 03 8 Printed in U.S.A.(Ed.ftM) Page 4 of 6 P526(N)28(K)2 MNLR 00 4. liability for any consequence, whether of America necessarily incurred as a direct o direct or Indirect, of war, invasion, act of result of bodily Injury. Foreign enemy,hostilities(whether war be Our reimbursement shall be limited as follows: declared or not), civil war, rebellion, 1. to the amount by which such expenses revolution, Insurrection or military or exceed the normal cost of returning the usurped power. No endorsement now or > subsequently attached to this policy shag officer or employee ff In good health,or w be construed as overriding or waiving this 2. in the event of death, to the amount by limitation unless specific reference is which such expenses exceed the normal made thereto. cost of returning the officer or employee If D. BNon W Pay alive and In good health. Before we reimburse you for the benefits to the In no event shall our reimbursement exceed the bodily injury by accident limit shown in M persons entitled to them,you must have them: Item 3.13.of the Information Page as respects 1. release you and us, In writing, of all any one such officer or employee whether responsibility for the Injury or death, dead or alive. ,°i 2. transfer to us their right to recover from H. Enderale Disease 0 others who may be responsible for their The word `disease" includes any endemic Injury or death, diseases. 3. cooperate with us and do everything The coverage applies as if endemic diseases necessary to enable us to enforce the right were included in the provisions of the workers' Ln N to recover from others. compensation law. Ln If the persons entitled to the benefits paid fail S. tongshas and Harbor Workers'Compensaii n �+ to do these things,our duty to reimburse ends # at once. 9 they claim damages from us for the Act Coverage f� Injury or death,our duty to reimburse ends at awwal Section C. Workers' Compenastl n once. Low is replaced by the following: E. Recovery From Others C. Workera'Compensation Law MM If we make a recovery from others, we will Workers' Compensation Law means the a: keep an amount equal to our expenses of workers or workers' compensation law and ® recovery and the benefits we reimbursed. We occupational disease law of each state or ® will pay the balance to the persons entitled to territory named in Item 3.A.of the Information ® ff. If persons entitled to the benefits make a Page and the Longshore and Harbor Workers' recovery from others, they must repay us for Compensation Act (33 USC Sections 901- sa� the amounts that we have reimbursed you. 950). ft Includes any amendments to those F. R imbursement for Actual toss Sustained laws that are in effect during the policy period. ft does not Include any other federal workers This endorsement provides only for or workers' compensation law, other federal reimbursement for the loss you actually occupational disease law or the provisions of sustain. In order for you to recover loss or any law that provide nonoccupationai disability _® expenses under this reimbursement you must: benefits. ifs 1. actually sustain and pay the loss or Part Two (Employers' Liability Insurance), C. expense In money after trial,or Exclusions, exclusion 8, does not apply to 2. secure our consent for the payment of the work subject to the Longshore and Harbor loss or expense. Workers'Compensation Act. 0. Repatriation This coverage does not apply to work subject f� � Our reimbursement includes the additional to the Defense Base Act, the Outer Continental Shelf Lands Act, or the expenses of repatriation to the United States Nonappropriated Fund Instrumentalities Act. son weer Form WC 99 03 03 6 Printed in U.SA (Ed.8100) Peg 5 f6 P52r.0 QX4912 Q� 00 W- 0 SECTION III iz 1. SCHEDULE OF COVERED STATES B. If a state,shown In Item 3.A.of the Information A. This endorsement only applies In the states Page, approves this endorsement after the z listed In this Schedule of Covered States. effective date of this policy,this endorsement w will apply to this policy. The coverage will apply In the new state on the effective date of the state approval. C. Schedule of Covered States: CA aa� Countersigned by Authorized Representative F nn WC 99 03 03 8 Printed in U.SA(Ed.&W) Pepe 6 of 6 P52(AX)28002 00 LL Policy #BA461M761212 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT z W This endorsement modifies insurance provided under the followng: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE–This endorsement broadens coverage.However,coverage for any injury,damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part,and these coverage broadening provisions do not apply to the extent that coverage Is excluded or limited by such an endorsement.The following listing Is a general cover- age description only.Limitations and exclusions may apply to these coverages.Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights,duties,and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT–INCREASED LIMIT C. EMPLOYEES AS INSURED 1. WAIVER OF DEDUCTIBLE–GLASS D. SUPPLEMENTARY PAYMENTS –INCREASED J. PERSONAL EFFECTS LIMITS K. AIRBAGS E. TRAILERS–INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION C. PHYSICAL DAMAGE – TRANSPORTATION EXPENSES–INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of The following is added to Paragraph A.1.,Who Is your business. n= An Insured, of SECTION II – LIABILITY COW 2. The following replaces Paragraph b. in B.S., ERAGE: Other Insurance, of SECTION IV – BUSI- Any person or organization who is required under NESS AUTO CONDITIONS: a written contract or agreement between you and b. For Hired Auto Physical Damage Cover- that person or organization, that is signed and age,the following are deemed to be cov- executed by you before the "bodily injury" or ered"autos"you own: m "property damage" occurs and that is in effect (t) Any covered "auto" you lease, hire, during the policy period,to be named as an addi- rent or borrow;and tional insured is an "insured" for Liability Cover- (2) Any covered"auto"hired or rented by age,but only for damages to which this Insurance your'employee" under a contract in applies and only to the extent that person or or- ganization qualifies as an "insured" under the that individual "employee's" name, Who Is An Insured provision contained in Section with your permission, while perform- - II ing duties related to the conduct of nT B. EMPLOYEE HIRED AUTO your business. e� 1. The following is added to Paragraph A.1., However,any"auto"that is leased,hired, Who Is An Insured, of SECTION 11 – LI- rented or ^° ABILITY COVERAGE; covered"auto". borrowed with a driver is not a C. EMPLOYEES AS INSURED •= An "employee"of yours is an "insured"while —' operating a covered "auto" hired or rented The following Is added to Paragraph A.1.,Who Is under a contract or agreement in that 'em- An Insured, of SECTION II – LIABILITY COV- pioyeeV' name, with your permission, while ERAGE: CA T4 20 07 10 ®2010 The Travelers Indemnity company.AN rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Serdces Office,Inc.vNth Its permission. 001639 P526""Z"W 00 COMMERCIAL AUTO p Any"employee"of yours is an'Insured"while us- (3) If a repair or replacement results in better " ing a covered"auto"you don't own,hire or borrow than like kind or quality,we will not pay for the in your business or your personal affairs. amount of betterment. > D. SUPPLEMENTARY PAYMENTS—INCREASED (4) A deductible equal to the highest Physical w LIMITS Damage deductible applicable to any owned 1. The following replaces Paragraph A.2.a.(2)of covered'auto SECTION b—LIABILITY COVERAGE: (5) This Coverage Extension does not apply to: (2) Up to $3,000 for cost of bail bonds (in- (a) Any "au(o" that is hired, rented or bor- cluding bonds for related traffic law viola- rowed with a driver;or lions) required because of an "accident" (b) Any "auto" that is hired, rented or bor- we cover. We do not have to furnish rowed from your"employee". these bonds. G. PHYSICAL DAMAGE — TRANSPORTATION 2. The following replaces Paragraph A.2.a.(4)of EXPENSES—INCREASED LIMIT SECTION II—LIABILITY COVERAGE: The following replaces the first sentence in Para- (4) All reasonable expenses incurred by the graph AA.a., Transportation Expenses, of "insured" at our request, including actual SECTION III — PHYSICAL DAMAGE COVER- loss of earnings up to $500 a day be- AGE: cause of time off from work. E. TRAILERS—INCREASED LOAD CAPACITY We will pay up to$50 per day to a maximum of $1,500 for temporary transportation expense In- The following replaces Paragraph C.1. of SEC- curred by you because of the total theft of a cov- TION I—COVERED AUTOS: ered"auto"of the private passenger type. 1. "Trailers" with a load capacity of 3,000 H. AUDIO, VISUAL AND DATA ELECTRONIC pounds or less designed primarily for travel EQUIPMENT—INCREASED LIMIT on public roads. Paragraph C.2.. Limit Of Insurance, of SEC- F. HIRED AUTO PHYSICAL DAMAGE TION III—PHYSICAL DAMAGE COVERAGE is The following is added to Paragraph A.4.,Cover- deleted. age Extensions, of SECTION III — PHYSICAL 1. WAIVER OF DEDUCTIBLE—GLASS DAMAGE COVERAGE: The following Is added to Paragraph D.,Deducti- Hired Auto Physical Damage Coverage ble, of SECTION III — PHYSICAL DAMAGE If hired "autos" are covered "autos" for Liability COVERAGE: Coverage but not covered "autos" for Physical No deductible for a covered "auto" will apply to Damage Coverage, and this policy also provides glass damage if the glass is repaired rather than Physical Damage Coverage for an owned"auto", replaced. then the Physical Damage Coverage is extended J. PERSONAL EFFECTS to"autos"that you hire, rent or borrow subject to the following; The following is added to Paragraph AA.,Cover- (1) The most we will pay for "loss" in any one age Extensions, of SECTION 111 — PHYSICAL "accident" to a hired, rented or borrowed DAMAGE COVERAGE: "auto"is the lesser of: Personal Effects Coverage (a) $50,000; We will pay up to $400 for"loss"to wearing ap- (b) The actual cash value of the damaged or parel and other personal effects which are: stolen property as of the time of the (1) Owned by an"insured";and "loss";or (2) In or on your covered"auto'. (c) The cost of repairing or replacing the This coverage only applies in the event of a total damaged or stolen property with other theft of your covered"auto". property of like kind and quality. No deductibles apply to Personal Effects cover- (2) An adjustment for depreciation and physical age. condition will be made In determining actual cash value in the event of a total"loss". Page 2 of 3 ®2010 The Travelers Indemnity Company.All rights reserved. CA T4 20 07 10 Includes copyrighted material of Insurance Services Otrlce,Inc.with Its permission. V52(AK12a"u2 k 00 W� COMMERCIAL AUTO 0 00 K. AIRBAGS (2) Any: The following is added to Paragraph B.3., Exclu- (a) Overdue lease or loan payments at the sions, of SECTION 111 — PHYSICAL DAMAGE time of the"loss"; COVERAGE: w (b) Financial penalties Imposed under a Exclusion 3.a.does not apply to'loss'to one or lease for excessive use, abnormal wear more airbags in a covered"auto"you own that In- and tear or high mileage; flate due to a cause other than a cause of"loss" (c) Security deposits not returned by the les- set forth in Paragraphs A.1.b. and A.1.c., but sor, only: a. If that"auto"is a covered`auto"for Compre- (d) Costs for extended warranties,Credit Life hensive Coverage under this policy; Insurance, Health, Accident or Disability Insurance purchased with the loan or b. The airbags are not covered under any war- lease;and ranty;and (e) Carry-over balances from previous loans c. The airbags were not intentionally inflated. or leases. We will pay up to a maximum of$1,000 for any iM. BLANKET WAIVER OF SUBROGATION one"loss". The following replaces Paragraph A.S.,Transfer L. AUTO LOAN LEASE GAP Of Rights Of Recovery Against Others To Us, The following is added to Paragraph AA.,Cover- of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS: DAMAGE COVERAGE: S. Transfer Of Rights Of Recovery Against Auto Loan Lease Gap Coverage for Private Others To Us Passenger Type Vehicles We waive any right of recovery we may have In the event of a total"loss"to a covered"auto"of against any person or organization to the ex- the private passenger type shown in the Schedule tent required of you by a written contract exe- or Declarations for which Physical Damage Cov- cuted prior to any "accident" or 'loss", pro- erage is provided,we will pay any unpaid amount vided that the"accident"or"loss"arises out of asto due on the lease or loan for such covered"auto" the operations contemplated by such con- '° less the following: tract.The waiver applies only to the person or (1) The amount paid under the Physical Damage organization designated in such contract. Coverage Section of the policy for that"auto"; a and ao om o� m� li= o� o� o tria m� .® CA T4 20 0710 @2010 The Travelers Indemnity C)mpany.Al rights reserved. Page 3 of 3 Includes copyrighted material of Insurance S?rvlces Office,Inc.with tts permission. 001640 P526IN12MIX12 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 09/16/2013 NAME OF INSURED: CSG Consultants Inc. 00 Precision Inspection - CSG W- 0 00 Additional Description of Operations/Remarks from Page 1: z w Additional Information: SUPP(05104)