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20-017 Amendment #2 Natron for Sports Center Fire Alarm System Replacement1
SECOND AMENDMENT TO AGREEMENT 381 BETWEEN
THE CITY OF CUPERTINO AND NATRON RESOURCES,
INC., FOR SPORTS CENTER FIRE ALARM SYSTEM
REPLACEMENT
This Second Amendment to Agreement 381 between the City of Cupertino and Natron
Resources, Inc., is by and between the City of Cupertino, a municipal corporation (hereinafter "City")
and Natron Resources, Inc., a Corporation (“Contractor”) whose address is 1480 Moraga Rd., Suite C
#229, Moraga, CA 94556, and is made with reference to the following:
RECITALS:
A. The City and Contractor entered into an Agreement for Sports Center Fire Alarm
System Replacement (“Original Agreement”) effective January 31, 2022, with a term expiring
on June 30, 2022.
B. The City and Contractor entered into a First Amended and Restated Agreement for
Sports Center Fire Alarm System Replacement (“First Amended Agreement”) effective July
25, 2022, with a term expiring on December 31, 2022.
C. The Original Agreement and First Amended Agreement are collectively referred to as
the “Agreement” unless otherwise indicated.
D. 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 3.1 of the Agreement is modified to read as follows:
Term. This Agreement begins on the Effective Date and ends on June 30, 2023, unless
terminated earlier as provided herein (“Contract Time”). The City’s appropriate department
head or City Manager may extend the Contract Time through a written amendment to this
Agreement, provided such extension does not include additional contract funds. Extensions
requiring additional contract funds are subject to the City’s purchasing policy.
2. Except as expressly modified herein, all other terms and covenants set forth in the
Agreement shall remain the same and shall be in full force and effect.
SIGNATURES CONTINUE ON THE FOLLOWING PAGE
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
City Attorney
ATTEST:
City Clerk
Date
NATRON RESOURCES, INC.
By
Title
Date
EXPENDITURE DISTRIBUTION
Item PO Number Amount
Original Agreement 2022-386 $22,200.00
Amendment 1 Extend term to 12/31/2022 $0.00
Amendment 2 Extend term to 06/30/2023 $0.00
Total $22,200.00
1429656.1
Jeffrey H. Ansley
President
Nov 9, 2022
Christopher D. Jensen
CIP Manager
Nov 9, 2022
Nov 9, 2022
1
FIRST AMENDMENT TO AGREEMENT 381 BETWEEN
THE CITY OF CUPERTINO AND NATRON
RESOURCES, INC., FOR SPORTS CENTER FIRE
ALARM SYSTEM REPLACEMENT
This First Amendment to Agreement 381 between the City of Cupertino and Natron
Resources, Inc., is by and between the City of Cupertino, a municipal corporation (hereinafter "City")
and Natron Resources, Inc., a Corporation (“Contractor”) whose address is 1480 Moraga Rd., Suite C
#229, Moraga, CA 94556, and is made with reference to the following:
RECITALS:
A. On January 31, 2022 Agreement 381 (“Agreement”) was entered into by and between
City and Contractor for Sports Center Fire Alarm System Replacement.
B. The City and the Consultant desire to continue Consultant’s services to the City under
the Agreement, and hereby affirm their intent that it remain in full force and effect as
amended and restated by this First Amendment.
NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as
follows:
1. Paragraph 3.1 of the Agreement is modified to read as follows:
Term. This Agreement begins on the Effective Date and ends on December 31, 2022, unless
terminated earlier as provided herein (“Contract Time”). The City’s appropriate department
head or City Manager may extend the Contract Time through a written amendment to this
Agreement, provided such extension does not include additional contract funds. Extensions
requiring additional contract funds are subject to the City’s purchasing policy.
2. Except as expressly modified herein, all other terms and covenants set forth in the
Agreement shall remain the same and shall be in full force and effect.
SIGNATURES CONTINUE ON THE FOLLOWING PAGE
2
IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement
to be executed.
CITY OF CUPERTINO NATRON RESOURCES, INC.
By By
Title Title
Date Date
APPROVED AS TO FORM
City Attorney
ATTEST:
City Clerk
Date
Oscar T Louie
Principal
Jul 25, 2022
Christopher D. Jensen
Director of Public Works
Jul 25, 2022
Jul 25, 2022
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:CONTACT
(A/C, No):FAX
E-MAILADDRESS:
PRODUCER
(A/C, No, Ext):PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$
$
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
EROTH-STATUTEPER
LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED $PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
6/8/2022
AssuredPartners Design Professionals Insurance Services,LLC
3697 Mt.Diablo Blvd Suite 230
Lafayette CA 94549
The Certificate Team
CertsDesignPro@AssuredPartners.com
License#:6003745 Sentinel Insurance Company 11000
NATRRES-01 Travelers Property Casualty Company of America 25674NatronResources,Inc.DBA:Zeiger Engineers,Inc.
1480 Moraga Road,Suite C #229
Moraga CA 94556
HARTFORD INSURANCE COMPANY 38288
101193575
A X 2,000,000
X 1,000,000
X Contractual Liab 10,000
Included 2,000,000
4,000,000
X X
Y Y 57SBWBM8201 6/29/2022 6/29/2023
4,000,000
A 2,000,000
X X
X NoOwnedAutos
Y Y 57SBWBM8201 6/29/2022 6/29/2023
A X X 2,000,000Y57SBWBM82016/29/2022Y 6/29/2023
2,000,000
X 10,000
C XY57WEGZR17866/16/2022 6/16/2023
1,000,000
1,000,000
1,000,000
B Professional Liability 105637491 6/22/2022 6/22/2023 Per Claim
Aggregate Limit
$2,000,000
$2,000,000
Insured owns no company vehicles;therefore,hired/non-owned auto is the maximum coverage that applies.The Umbrella Policy is follow form to its underlying
Policies:General Liability/Auto Liability/Employers Liability.
RE:Project:Cupertino Sports Center Fire Panel
The City of Cupertino,its City Council,officers,officials,employees,agents,servants and volunteers are named as additional insureds as respects general
liability as required per written contract or agreement.General Liability is Primary/Non-Contributory per policy form wording.Insurance coverage includes waiver
of subrogation per the attached endorsement(s).
30 Day Notice of Cancellation
City of Cupertino
10300 Torre Ave
Cupertino CA 95014
ABCDEFGHIJ
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT - AGGREGATE LIMITS (PER PROJECT)
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
A. D.4.Section LIABILITY AND MEDICAL EXPENSES If the applicable “project” has been abandoned,
LIMITS OF INSURANCE is amended as follows:delayed, or abandoned and then restarted, or if
the authorized contracting parties deviate from1.D.The General Aggregate Limit under Section
plans, blueprints, designs, specifications orLIABILITY AND MEDICAL EXPENSES LIMIT
timetables, the “project” will still be deemed toOF INSURANCE applies separately to each of
be the same “project”.your "projects".
5.D.The provisions of Section LIABILITY AND2.The limits shown in the Declarations for Liability
MEDICAL EXPENSES LIMIT OF INSURANCEand Medical Expenses, Damage To Premises
not otherwise modified by this endorsementRented To You and Medical Expenses continue
shall continue to apply as stipulated.to apply.
B.Additional Definitions3.When coverage for liability arising out of the
G.“products-completed operations hazard” is The following definition is added to Section
provided, any payments for damages because LIABILITY AND MEDICAL EXPENSES
of “bodily injury” or “property damage” included DEFINITIONS:
in the “products-completed operations hazard”1.“Project” means “your work” at location(s) away
will reduce the Products-Completed Operations from premises owned or rented to you.
Aggregate Limit, and not reduce the General
Aggregate Limit.
Form SS 04 33 04 05 Page 1 of 1
© 2005, The Hartford
Policy #57SBWBM8201
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Form SS 51 14 04 17 Page 1 of 1
© 2017, The Hartford
ADDITIONAL INSURED PROVISIONS - CALIFORNIA
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
A.It is agreed that paragraph (2)of subsections 6.d.
and 6.f.of Section C. - WHO IS AN INSURED is
replaced by the following:
(2)The insurance afforded by paragraph
(1)above
does not apply if your acts or omissions, or the
acts or omissions of those acting on your behalf,
that are alleged to have caused the "bodily
injury", "property damage" or "personal and
advertising injury", involve professional
architectural, engineering or surveying services,
including but not limited to:
(a)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;
(b)Supervisory, inspection, quality control,
architectural, engineering or surveying
activities or services;
(c)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;
(d)Monitoring, sampling, or testing service
necessary to perform any of the services
included in a. b. or c. above;
(e)Supervision, hiring, employment, training or
monitoring of others who are performing
any of the services included in a., b. or c.
above.
The insurance afforded to such additional
insured:
(a)Only applies to the extent permitted by law;
and
(b)Will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B.It is agreed that the following paragraphs are added
to the end of subsections 1.and 8.of Section F-
OPTIONAL ADDITIONAL INSURED
COVERAGES;and it is agreed the following
paragraphs replace section b.of subsection 9.of
Section F. - OPTIONAL ADDITIONAL INSURED
COVERAGES.These paragraphs do not attach or
amend the language of any of the other subsections
of Section F - OPTIONAL ADDITIONAL INSURED
COVERAGES:
The insurance afforded by this subsection does not
apply if your acts or omissions, or the acts or
omissions of those acting on your behalf, that are
alleged to have caused the "bodily injury", "property
damage" or "personal and advertising injury",
involve professional architectural, engineering or
surveying services, including but not limited to:
(a)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;
(b)Supervisory, inspection, quality control,
architectural, engineering or surveying
activities or services;
(c)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;
(d)Monitoring, sampling, or testing service
necessary to perform any of the services
included in a. b. or c. above;
(e)Supervision, hiring, employment, training or
monitoring of others who are performing any
of the services included in a., b. or c. above.
The insurance afforded to such additional insured:
(a)Only applies to the extent permitted by law;
and
(b)Will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
3ROLF\57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
(b) b.Rented to, in the care, custody or Coverage under this provision does not
control of, or over which physical apply to:
control is being exercised for any (1)"Bodily injury" or "property damage"purpose by you, any of your that occurred; or"employees", "volunteer workers",(2)"Personal and advertising injury"any partner or member (if you are arising out of an offense committeda partnership or joint venture), or
before you acquired or formed the any member (if you are a limited
organization.liability company).
4. Operator Of Mobile Equipmentb. Real Estate Manager
With respect to "mobile equipment" registered inAny person (other than your "employee" or
your name under any motor vehicle registration"volunteer worker"), or any organization
law, any person is an insured while driving suchwhile acting as your real estate manager.
equipment along a public highway with yourc. Temporary Custodians Of Your permission. Any other person or organizationPropertyresponsible for the conduct of such person isAny person or organization having proper also an insured, but only with respect to liabilitytemporary custody of your property if you arising out of the operation of the equipment, anddie, but only:only if no other insurance of any kind is available
(1)With respect to liability arising out of the to that person or organization for this liability.
maintenance or use of that property; and However, no person or organization is an insured
with respect to:(2)Until your legal representative has
been appointed.a."Bodily injury" to a co-"employee" of the
person driving the equipment; ord. Legal Representative If You Die
b."Property damage" to property owned by,Your legal representative if you die, but rented to, in the charge of or occupied byonly with respect to duties as such. That you or the employer of any person who isrepresentative will have all your rights and an insured under this provision.duties under this insurance.
5. Operator of Nonowned Watercrafte. Unnamed Subsidiary
With respect to watercraft you do not own thatAny subsidiary and subsidiary thereof, of is less than 51 feet long and is not being usedyours which is a legally incorporated entity to carry persons for a charge, any person is anof which you own a financial interest of insured while operating such watercraft withmore than 50% of the voting stock on the your permission. Any other person oreffective date of this Coverage Part.organization responsible for the conduct ofThe insurance afforded herein for any such person is also an insured, but only withsubsidiary not shown in the Declarations respect to liability arising out of the operationas a named insured does not apply to of the watercraft, and only if no otherinjury or damage with respect to which an insurance of any kind is available to thatinsured under this insurance is also an person or organization for this liability.insured under another policy or would be However, no person or organization is anan insured under such policy but for its insured with respect to:termination or upon the exhaustion of its
limits of insurance.a."Bodily injury" to a co-"employee" of the
person operating the watercraft; or3. Newly Acquired Or Formed Organization
b."Property damage" to property owned by,Any organization you newly acquire or form,rented to, in the charge of or occupied byother than a partnership, joint venture or you or the employer of any person who islimited liability company, and over which you an insured under this provision.maintain financial interest of more than 50% of
the voting stock, will qualify as a Named 6. Additional Insureds When Required By
Insured if there is no other similar insurance Written Contract, Written Agreement Or
available to that organization. However:Permit
a.Coverage under this provision is afforded The person(s) or organization(s) identified in
only until the 180th day after you acquire a. f.Paragraphs through below are additional
or form the organization or the end of the insureds when you have agreed, in a written
policy period, whichever is earlier; and
Form SS 00 08 04 05 Page 11 of 24
3ROLF\57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
(e)contract, written agreement or because of a Any failure to make such
permit issued by a state or political inspections, adjustments, tests or
subdivision, that such person or organization servicing as the vendor has
be added as an additional insured on your agreed to make or normally
policy, provided the injury or damage occurs undertakes to make in the usual
subsequent to the execution of the contract or course of business, in connection
agreement, or the issuance of the permit. with the distribution or sale of the
products;A person or organization is an additional (f)Demonstration, installation,insured under this provision only for that servicing or repair operations,period of time required by the contract,except such operations performedagreement or permit.at the vendor's premises inHowever, no such person or organization is an connection with the sale of theadditional insured under this provision if such product;person or organization is included as an (g)Products which, after distributionadditional insured by an endorsement issued or sale by you, have been labeledby us and made a part of this Coverage Part,or relabeled or used as aincluding all persons or organizations added container, part or ingredient of anyas additional insureds under the specific other thing or substance by or foradditional insured coverage grants in Section the vendor; orF.– Optional Additional Insured Coverages.
(h)"Bodily injury" or "propertya. Vendors damage" arising out of the soleAny person(s) or organization(s) (referred to negligence of the vendor for itsbelow as vendor), but only with respect to own acts or omissions or those of"bodily injury" or "property damage" arising its employees or anyone elseout of "your products" which are distributed acting on its behalf. However, thisor sold in the regular course of the vendor's exclusion does not apply to:business and only if this Coverage Part (i)The exceptions contained inprovides coverage for "bodily injury" or (d) (f)Subparagraphs or ; or"property damage" included within the
(ii)"products-completed operations hazard". Such inspections, adjustments,
tests or servicing as the vendor(1)The insurance afforded to the vendor has agreed to make or normallyis subject to the following additional undertakes to make in the usualexclusions:course of business, inThis insurance does not apply to:connection with the distribution
(a)"Bodily injury" or "property or sale of the products.
damage" for which the vendor is (2)This insurance does not apply to anyobligated to pay damages by insured person or organization fromreason of the assumption of whom you have acquired such products,liability in a contract or agreement.or any ingredient, part or container,This exclusion does not apply to entering into, accompanying orliability for damages that the containing such products.vendor would have in the absence b. Lessors Of Equipmentof the contract or agreement;
(1)Any person or organization from(b)Any express warranty whom you lease equipment; but onlyunauthorized by you;with respect to their liability for "bodily(c)Any physical or chemical change injury", "property damage" orin the product made intentionally "personal and advertising injury"by the vendor;caused, in whole or in part, by your
(d)Repackaging, except when maintenance, operation or use of
unpacked solely for the purpose of equipment leased to you by such
inspection, demonstration, testing,person or organization.
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the
original container;
Page 12 of 24 Form SS 00 08 04 05
3ROLF\57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
(2) e. Permits Issued By State Or PoliticalWith respect to the insurance afforded
Subdivisionsto these additional insureds, this
insurance does not apply to any (1)Any state or political subdivision, but"occurrence" which takes place after only with respect to operationsyou cease to lease that equipment.performed by you or on your behalf for
c. Lessors Of Land Or Premises which the state or political subdivision
has issued a permit.(1)Any person or organization from
(2)whom you lease land or premises, but With respect to the insurance afforded
only with respect to liability arising out to these additional insureds, this
of the ownership, maintenance or use insurance does not apply to:
of that part of the land or premises (a)"Bodily injury", "property damage"leased to you.or "personal and advertising
(2)With respect to the insurance afforded injury" arising out of operations
to these additional insureds, this performed for the state or
insurance does not apply to: municipality; or
(a) (b)Any "occurrence" which takes "Bodily injury" or "property damage"
place after you cease to lease that included within the "products-
land or be a tenant in that completed operations hazard".
premises; or f. Any Other Party
(b)Structural alterations, new (1)Any other person or organization whoconstruction or demolition a.is not an insured under Paragraphsoperations performed by or on ethrough . above, but only withbehalf of such person or respect to liability for "bodily injury",organization."property damage" or "personal and
d. Architects, Engineers Or Surveyors advertising injury" caused, in whole or
in part, by your acts or omissions or(1)Any architect, engineer, or surveyor, but the acts or omissions of those actingonly with respect to liability for "bodily on your behalf:injury", "property damage" or "personal
(a)and advertising injury" caused, in whole In the performance of your
or in part, by your acts or omissions or ongoing operations;
the acts or omissions of those acting on (b)In connection with your premisesyour behalf:owned by or rented to you; or
(a)In connection with your premises;(c)In connection with "your work" andorincluded within the "products-
(b)In the performance of your completed operations hazard", but
ongoing operations performed by only if
you or on your behalf.(i)The written contract or written
(2)With respect to the insurance afforded agreement requires you to
to these additional insureds, the provide such coverage to
following additional exclusion applies: such additional insured; and
(ii)This insurance does not apply to This Coverage Part provides
"bodily injury", "property damage" or coverage for "bodily injury" or
"personal and advertising injury" "property damage" included
arising out of the rendering of or the within the "products-
failure to render any professional completed operations hazard".
services by or for you, including:(2)With respect to the insurance afforded
(a)The preparing, approving, or to these additional insureds, this
failure to prepare or approve, insurance does not apply to:
maps, shop drawings, opinions,"Bodily injury", "property damage" orreports, surveys, field orders, "personal and advertising injury"change orders, designs or arising out of the rendering of, or thedrawings and specifications; or failure to render, any professional
(b)Supervisory, inspection, architectural, engineering or surveying
architectural or engineering services, including:
activities.
Form SS 00 08 04 05 Page 13 of 24
3ROLF\57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
(a)The preparing, approving, or This General Aggregate limit does not
failure to prepare or approve, apply to "property damage" to premises
maps, shop drawings, opinions, while rented to you or temporarily
reports, surveys, field orders, occupied by you with permission of the
change orders, designs or owner, arising out of fire, lightning or
drawings and specifications; or explosion.
(b) 3. Each Occurrence LimitSupervisory, inspection,
architectural or engineering 2.a. 2.bSubject to or above, whicheveractivities.applies, the most we will pay for the sum of all
The limits of insurance that apply to additional damages because of all "bodily injury",
D.insureds are described in Section – Limits "property damage" and medical expenses
Of Insurance. arising out of any one "occurrence" is the
Liability and Medical Expenses Limit shown inHow this insurance applies when other the Declarations.insurance is available to an additional insured
is described in the Other Insurance Condition The most we will pay for all medical expenses
E.in Section – Liability And Medical Expenses because of "bodily injury" sustained by any
General Conditions. one person is the Medical Expenses Limit
shown in the Declarations.No person or organization is an insured with
4. Personal And Advertising Injury Limitrespect to the conduct of any current or past
partnership, joint venture or limited liability 2.b.Subject to above, the most we will pay forcompany that is not shown as a Named Insured in the sum of all damages because of allthe Declarations."personal and advertising injury" sustained by
any one person or organization is the PersonalD. LIABILITY AND MEDICAL EXPENSES
and Advertising Injury Limit shown in theLIMITS OF INSURANCE Declarations.1. The Most We Will Pay 5. Damage To Premises Rented To You LimitThe Limits of Insurance shown in the The Damage To Premises Rented To YouDeclarations and the rules below fix the most Limit is the most we will pay under Businesswe will pay regardless of the number of:Liability Coverage for damages because ofa.Insureds;"property damage" to any one premises, while
b.Claims made or "suits" brought; or rented to you, or in the case of damage by fire,
lightning or explosion, while rented to you orc.Persons or organizations making claims or
temporarily occupied by you with permission ofbringing "suits".
the owner.2. Aggregate Limits
In the case of damage by fire, lightning orThe most we will pay for:explosion, the Damage to Premises Rented Toa.Damages because of "bodily injury" and You Limit applies to all damage proximately"property damage" included in the caused by the same event, whether such"products-completed operations hazard" is damage results from fire, lightning or explosionthe Products-Completed Operations or any combination of these.Aggregate Limit shown in the 6. How Limits Apply To Additional InsuredsDeclarations.
The most we will pay on behalf of a person orb.Damages because of all other "bodily organization who is an additional insuredinjury", "property damage" or "personal under this Coverage Part is the lesser of:and advertising injury", including medical
a.The limits of insurance specified in aexpenses, is the General Aggregate Limit
written contract, written agreement orshown in the Declarations.
permit issued by a state or politicalThis General Aggregate Limit applies subdivision; orseparately to each of your "locations"
b.The Limits of Insurance shown in theowned by or rented to you.
Declarations."Location" means premises involving the
Such amount shall be a part of and not in same or connecting lots, or premises
addition to the Limits of Insurance shown in whose connection is interrupted only by a
the Declarations and described in this Section.street, roadway or right-of-way of a
railroad.
Page 14 of 24 Form SS 00 08 04 05
3ROLF\57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
(1)If more than one limit of insurance under this Immediately send us copies of any
policy and any endorsements attached thereto demands, notices, summonses or
applies to any claim or "suit", the most we will pay legal papers received in connection
under this policy and the endorsements is the with the claim or "suit";
single highest limit of liability of all coverages (2)Authorize us to obtain records andapplicable to such claim or "suit". However, this other information;paragraph does not apply to the Medical Expenses (3)Cooperate with us in the investigation, 3.limit set forth in Paragraph above.settlement of the claim or defense The Limits of Insurance of this Coverage Part apply against the "suit"; andseparately to each consecutive annual period and to (4)Assist us, upon our request, in theany remaining period of less than 12 months, starting enforcement of any right against anywith the beginning of the policy period shown in the person or organization that may beDeclarations, unless the policy period is extended liable to the insured because of injuryafter issuance for an additional period of less than 12 or damage to which this insurancemonths. In that case, the additional period will be may also apply.deemed part of the last preceding period for purposes d. Obligations At The Insured's Own Costof determining the Limits of Insurance.
No insured will, except at that insured's ownE. LIABILITY AND MEDICAL EXPENSES cost, voluntarily make a payment, assumeGENERAL CONDITIONS any obligation, or incur any expense, other
than for first aid, without our consent.1. Bankruptcy
e. Additional Insured's Other InsuranceBankruptcy or insolvency of the insured or of
the insured's estate will not relieve us of our If we cover a claim or "suit" under this
obligations under this Coverage Part.Coverage Part that may also be covered
by other insurance available to an2. Duties In The Event Of Occurrence,
additional insured, such additional insuredOffense, Claim Or Suit
must submit such claim or "suit" to thea. Notice Of Occurrence Or Offense other insurer for defense and indemnity.You or any additional insured must see to However, this provision does not apply toit that we are notified as soon as the extent that you have agreed in apracticable of an "occurrence" or an written contract, written agreement oroffense which may result in a claim. To permit that this insurance is primary andthe extent possible, notice should include:non-contributory with the additional(1)How, when and where the "occurrence"insured's own insurance.or offense took place;f. Knowledge Of An Occurrence, Offense,(2)The names and addresses of any Claim Or Suitinjured persons and witnesses; and a. b.Paragraphs and apply to you or to(3)The nature and location of any injury any additional insured only when suchor damage arising out of the "occurrence", offense, claim or "suit" is"occurrence" or offense.known to:
b. Notice Of Claim (1)You or any additional insured that is
an individual;If a claim is made or "suit" is brought
against any insured, you or any additional (2)Any partner, if you or an additionalinsured must:insured is a partnership;
(1)Immediately record the specifics of the (3)Any manager, if you or an additionalclaim or "suit" and the date received;insured is a limited liability company;and (4)Any "executive officer" or insurance(2)Notify us as soon as practicable.manager, if you or an additional
insured is a corporation;You or any additional insured must see to
it that we receive a written notice of the (5)Any trustee, if you or an additionalclaim or "suit" as soon as practicable.insured is a trust; or
c. Assistance And Cooperation Of The (6)Any elected or appointed official, if youInsuredor an additional insured is a political
subdivision or public entity.You and any other involved insured must:
Form SS 00 08 04 05 Page 15 of 24
3ROLF\57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
f. (3)This Paragraph applies separately to We have issued this policy in reliance
you and any additional insured. upon your representations.
3. Financial Responsibility Laws b. Unintentional Failure To Disclose
Hazardsa.When this policy is certified as proof of
financial responsibility for the future under If unintentionally you should fail to disclose
the provisions of any motor vehicle all hazards relating to the conduct of your
financial responsibility law, the insurance business at the inception date of this
provided by the policy for "bodily injury"Coverage Part, we shall not deny any
liability and "property damage" liability will coverage under this Coverage Part
comply with the provisions of the law to because of such failure.
the extent of the coverage and limits of 7. Other Insuranceinsurance required by that law.If other valid and collectible insurance isb.With respect to "mobile equipment" to available for a loss we cover under thiswhich this insurance applies, we will Coverage Part, our obligations are limited asprovide any liability, uninsured motorists,follows:underinsured motorists, no-fault or other a. Primary Insurancecoverage required by any motor vehicle
b.law. We will provide the required limits for This insurance is primary except when
those coverages. below applies. If other insurance is also
primary, we will share with all that other4. Legal Action Against Us c.insurance by the method described inNo person or organization has a right under below.this Coverage Form:b. Excess Insurancea.To join us as a party or otherwise bring us
This insurance is excess over any of theinto a "suit" asking for damages from an
other insurance, whether primary, excess,insured; or
contingent or on any other basis:b.To sue us on this Coverage Form unless
(1) Your Workall of its terms have been fully complied
with.That is Fire, Extended Coverage,
Builder's Risk, Installation Risk orA person or organization may sue us to recover
similar coverage for "your work";on an agreed settlement or on a final judgment
against an insured; but we will not be liable for (2) Premises Rented To Youdamages that are not payable under the terms of That is fire, lightning or explosionthis insurance or that are in excess of the insurance for premises rented to youapplicable limit of insurance. An agreed or temporarily occupied by you withsettlement means a settlement and release of permission of the owner;liability signed by us, the insured and the
(3) Tenant Liabilityclaimant or the claimant's legal representative.
That is insurance purchased by you to5. Separation Of Insureds
cover your liability as a tenant forExcept with respect to the Limits of Insurance,"property damage" to premises rentedand any rights or duties specifically assigned to you or temporarily occupied by youin this policy to the first Named Insured, this with permission of the owner;insurance applies:
(4) Aircraft, Auto Or Watercrafta.As if each Named Insured were the only
If the loss arises out of the maintenanceNamed Insured; and
or use of aircraft, "autos" or watercraft tob.Separately to each insured against whom g.the extent not subject to Exclusion ofa claim is made or "suit" is brought.A.Section – Coverages.6. Representations (5) Property Damage To Borroweda. When You Accept This Policy Equipment Or Use Of Elevators
By accepting this policy, you agree:If the loss arises out of "property
damage" to borrowed equipment or(1)The statements in the Declarations
the use of elevators to the extent notare accurate and complete;
k. A.subject to Exclusion of Section –(2)Those statements are based upon Coverages.representations you made to us; and
Page 16 of 24 Form SS 00 08 04 05
3ROLF\57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
(6) When You Are Added As An When this insurance is excess over other
Additional Insured To Other insurance, we will pay only our share of
Insurance the amount of the loss, if any, that
exceeds the sum of:That is other insurance available to
(1)you covering liability for damages The total amount that all such other
arising out of the premises or insurance would pay for the loss in the
operations, or products and completed absence of this insurance; and
operations, for which you have been (2)The total of all deductible and self-added as an additional insured by that insured amounts under all that otherinsurance; or insurance.
(7) When You Add Others As An We will share the remaining loss, if any, withAdditional Insured To This any other insurance that is not described inInsurancethis Excess Insurance provision and was not
That is other insurance available to an bought specifically to apply in excess of the
additional insured. Limits of Insurance shown in the
Declarations of this Coverage Part.However, the following provisions
c. Method Of Sharingapply to other insurance available to
any person or organization who is an If all the other insurance permitsadditional insured under this Coverage contribution by equal shares, we will followPart:this method also. Under this approach,
(a) Primary Insurance When each insurer contributes equal amounts
Required By Contract until it has paid its applicable limit of
insurance or none of the loss remains,This insurance is primary if you whichever comes first.have agreed in a written contract,
written agreement or permit that If any of the other insurance does not permit
this insurance be primary. If other contribution by equal shares, we will
insurance is also primary, we will contribute by limits. Under this method, each
share with all that other insurance insurer’s share is based on the ratio of its
c.by the method described in applicable limit of insurance to the total
below. applicable limits of insurance of all insurers.
(b) Primary And Non-Contributory 8. Transfer Of Rights Of Recovery Against
To Other Insurance When Others To Us
Required By Contract a. Transfer Of Rights Of Recovery
If you have agreed in a written If the insured has rights to recover all orcontract, written agreement or part of any payment, includingpermit that this insurance is Supplementary Payments, we have madeprimary and non-contributory with under this Coverage Part, those rights arethe additional insured's own transferred to us. The insured must doinsurance, this insurance is nothing after loss to impair them. At ourprimary and we will not seek request, the insured will bring "suit" orcontribution from that other transfer those rights to us and help usinsurance.enforce them. This condition does not
(a) (b)Paragraphs and do not apply to apply to Medical Expenses Coverage.
other insurance to which the additional b. Waiver Of Rights Of Recovery (Waiverinsured has been added as an Of Subrogation)additional insured.If the insured has waived any rights ofWhen this insurance is excess, we will recovery against any person orhave no duty under this Coverage Part to organization for all or part of any payment,defend the insured against any "suit" if any including Supplementary Payments, weother insurer has a duty to defend the have made under this Coverage Part, weinsured against that "suit". If no other also waive that right, provided the insuredinsurer defends, we will undertake to do waived their rights of recovery againstso, but we will be entitled to the insured's such person or organization in a contract,rights against all those other insurers.agreement or permit that was executed
prior to the injury or damage.
Form SS 00 08 04 05 Page 17 of 24
3ROLF\57SBWBM8201
ABCDEFGHIJ
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
HIRED AUTO AND NON-OWNED AUTO
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
This coverage is subject to all provisions in the moved from the place where they are
BUSINESS LIABILITY COVERAGE FORM not accepted by the "insured" for movement into
expressly modified herein: or onto the covered "auto"; or
c.After the "pollutants" or any property in
which the "pollutants" are contained areA. Amended Coverage:moved from the covered "auto" to the placeCoverage is extended to "bodily injury" and where they are finally delivered, disposed of"property damage" arising out of the use of a "hired or abandoned by the "insured".auto" and "non-owned auto".a.Paragraph above does not apply to fuels,B. Paragraph B. EXCLUSIONS is amended as lubricants, fluids, exhaust gases or otherfollows:similar "pollutants" that are needed for or
1.Exclusion g. Aircraft, Auto or Watercraft does result from the normal electrical, hydraulic
not apply to a "hired auto" or a "non-owned or mechanical functioning of the covered
auto"."auto" or its parts, if:
2.Exclusion e. Employers Liability does not (1)The "pollutants" escape, seep, migrate,
apply to "bodily injury" to domestic "employees"or are discharged or released directly
not entitled to workers’ compensation benefits from an "auto" part designed by its
or to liability assumed by the "insured" under an manufacturer to hold, store, receive, or
"insured contract".dispose of such "pollutants"; and
3. f. PollutionExclusion is replaced by the (2) The "bodily injury" and "property
following:damage" does not arise out of the
operation of any equipment listed in"Bodily injury" or "property damage" arising out paragraphs 15.b.and 15.c.of theof the actual, alleged or threatened discharge,definition of "mobile equipment".dispersal, seepage, migration, release or
escape of "pollutants":Paragraphs b.and c.above do not apply to
"accidents" that occur away from premisesa.That are, or that are contained in any owned by or rented to an "insured" with property that is:respect to "pollutants" not in or upon a (1)Being transported or towed by, handled,covered "auto" if:or handled for movement into, onto or (1)The "pollutants" or any property infrom, the covered "auto";which the "pollutants" are contained are(2)Otherwise in the course of transit by or upset, overturned or damaged as aon behalf of the "insured"; or result of the maintenance or use of a
(3)Being stored, disposed of, treated or covered "auto"; and
processed in or upon the covered
"auto".
b.Before the "pollutants" or any property in
which the "pollutants" are contained are
Form SS 04 38 09 09 Page 1 of 3
© 2009, The Hartford
(Includes copyrighted material of ISO Properties, Inc., with its permission)
3ROLF\57SBWBM8201
(2)The discharge, dispersal, seepage,company) for an "auto" owned by him or her
migration, release or escape of the or a member of his or her household.
"pollutants" is caused directly by such d.Anyone liable for the conduct of an "insured"upset, overturn or damage as a result of described above but only to the extent of thatthe maintenance or use of a covered liability."auto".D.With respect to the operation of a "hired auto" and4.With respect to this coverage, the following "non-owned auto", the following additionaladditional exclusions apply:conditions apply:
a. Fellow employee 1. OTHER INSURANCE
Coverage does not apply to "bodily injury" to a.Except for any liability assumed under anany fellow "employee" of the "insured""insured contract" the insurance provided byarising out of the operation of an "auto"this Coverage Form is excess over anyowned by the "insured" in the course of the other collectible insurance.fellow "employee’s" employment.However, if your business is the selling,b. Care, custody or control servicing, repairing, parking or storage of
Coverage does not apply to "property "autos", the insurance provided by this
damage" involving property owned or endorsement is primary when covered
transported by the "insured" or in the "bodily injury" or "property damage" arises
"insured’s" care, custody or control. out of the operation of a customer’s "auto"
by you or your "employee".C.With respect to "hired auto" and "non-owned auto"
coverage, Paragraph C. WHO IS AN INSURED is b.When this Coverage Form and any other
deleted and replaced by the following: Coverage Form or policy covers on the
same basis, either excess or primary, weThe following are "insureds":will pay only our share. Our share is thea.You.proportion that the Limit of Insurance of our
b.Your "employee" while using with your Coverage Form bears to the total of the
permission:limits of all the Coverage Forms and policies
covering on the same basis.(1)An "auto" you hire or borrow; or
2. TWO OR MORE COVERAGE FORMS OR(2)An "auto" you don’t own, hire or borrow in POLICIES ISSUED BY USyour business or personal affairs; or
If the Coverage Form and any other Coverage(3)An "auto" hired or rented by your Form or policy issued to you by us or any"employee" on your behalf and at your company affiliated with us apply to the samedirection."accident", the aggregate maximum Limit ofc.Anyone else while using a "hired auto" or "non-Insurance under all the Coverage Forms orowned auto" with your permission except:policies shall not exceed the highest applicable
(1)The owner or anyone else from whom you Limit of Insurance under any one Coverage
hire or borrow an "auto".Form or policy. This condition does not apply to
any Coverage Form or policy issued by us or an(2)Someone using an auto while he or she is affiliated company specifically to apply asworking in a business of selling, servicing,excess insurance over this Coverage Form.repairing, parking or storing "autos" unless
that business is yours.E.The following definitions are added:
(3)Anyone other than your "employees",G. LIABILITY AND MEDICAL EXPENSES
partners (if you are a partnership), members DEFINITIONS:
(if you are a limited liability company), or a 1."Hired auto" means any "auto" you lease,lessee or borrower or any of their hire, rent or borrow. This does not include"employees", while moving property to or any auto you lease, hire, rent or borrowfrom an "auto".from any of your "employees", your partners
(4)A partner (if you are a partnership), or a (if you are a partnership), members (if you
member (if you are a limited liability are a limited liability company),
Page 2 of 3 Form SS 04 38 09 09
3ROLF\57SBWBM8201
or your "executive officers" or members of
their households.
This does not include a long-term leased
"auto" that you insure as an owned "auto"
under any other auto liability insurance
policy or a temporary substitute for an
"auto" you own that is out of service
because of its breakdown, repair, servicing
or destruction.
2."Non-owned auto " means any "auto" you
do not own, lease, hire, rent or borrow
which is used in connection with your
business. This includes:
a."Autos" owned by your "employees" your
partners (if you are a partnership),
members (if you are a limited liability
company), or your "executive officers",
or members of their households, but
only while used in your business or your
personal affairs.
b.Customer’s "auto" that is in your care,
custody or control for service.
Form SS 04 38 09 09 Page 3 of 3
3ROLF\57SBWBM8201
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)
Process Date:
Page 1 of 6
Policy Expiration Date:
© 2000, The Hartford
WORKERS’ COMPENSATION BROAD FORM ENDORSEMENT
EXTENDED OPTIONS
Endorsement Number:Policy Number:
Effective Date: Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address:
Section I of this endorsement expands coverage provided under WC 00 00 00.
Section II of this endorsement provides additional coverage usually only provided by endorsement.
Section III of this endorsement is a Schedule of Covered States.
You may use the index to locate these coverage features quickly:
INDEX
SUBJECT PAGE SUBJECT PAGE
SECTION I
PARTS ONE and TWO
01 We Will Also Pay
PART - THREE
02 How This Insurance Works
PART - SIX
03 Transfer of Your Rights and Duties
04 Liberalization
SECTION II
VOLUNTARY COMPENSATION
INSURANCE
05 Voluntary Compensation Insurance
A. How This Insurance Applies
B. We Will Pay
C. Exclusions
D. Before We Pay
E. Recovery From Others
F. Employers’ Liability Insurance
EMPLOYERS’ LIABILITY STOP GAP
ENDORSEMENT
06 Employers’ Liability Stop Gap
Coverage
A. Stop Gap Coverage Limited to
Montana, North Dakota, Ohio,
Washington, West Virginia and
Wyoming
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
B. Part One Does Not Apply
C. Application of Coverage
D. Additional Exclusions
E. West Virginia
EXTENDED OPTIONS
01 Employers’ Liability Insurance
02 Unintentional Failure to Disclose
Hazards
03 Waiver of Our Right to Recover from
Others
04 Foreign Voluntary Compensation
A. How This Reimbursement Applies
B. We Will Reimburse
C. Exclusions
D. Before We Pay
E. Recovery From Others
F. Reimbursement For Actual Loss
Sustained
G. Repatriation
H. Endemic Disease
05 Longshore and Harbor Workers’
Compensation Act Coverage
Endorsement
SECTION III
01 Schedule of Covered States
3
3
3
3
4
4
4
4
4
4
4
4
5
5
5
5
5
5
6
6
57WEGZR1786
06/16/2022
Natron Resources,Inc.DBA:Zeiger Engineers,Inc.
1480 Moraga Road,Suite C #229
Moraga,CA 94556
06/16/20236/8/2022
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 2 of 6
SECTION I
PARTS ONE and TWO
1.WE WILL ALSO PAY
D.We Will Also Pay of Part One (WORKERS’
COMPENSATION INSURANCE); and
E.We Will Also Pay of Part Two
(EMPLOYERS’LIABILITY INSURANCE)is
replaced by the following:
We Will Also Pay
We will also pay these costs,in addition to
other amounts payable under this insurance,
as part of any claim,proceeding,or suit we
defend:
1.reasonable expenses incurred at our
request,INCLUDING loss of earnings;
2.premiums for bonds to release
attachments and for appeal bonds in
bond amounts up to the limit of our
liability under this insurance;
3.litigation costs taxed against you;
4.interest on a judgment as required by law
until we offer the amount due under this
law; and
5.expenses we incur.
PART THREE
2.How This Insurance Applies
Paragraph 4.of A.How This Insurance Applies of
Part 3 (Other States Insurance)is replaced by the
following:
4.If you have work on the effective date of this
policy in any state not listed in Item 3.A.of the
Information Page,coverage will not be afforded
for that state unless we are notified within sixty
days.
PART SIX
3.Transfer Of Your Rights and Duties
C.Transfer Of Your Rights and Duties of Part 6
(Conditions) is replaced by the following:
Your rights or duties under this policy may not be
transferred without our written consent.
If you die and we receive notice within sixty days
after your death,we will cover your legal
representative as insured.
4.Liberalization
If we adopt a change in this form that would 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 II
VOLUNTARY COMPENSATION ANDEMPLOYERS’
LIABILITY COVERAGE
5.Voluntary Compensation Insurance
A.How This Insurance Applies
This insurance applies to bodily injury by
accident or bodily injury by disease.Bodily
injury includes resulting death.
1.The bodily injury must be sustained by
any officer or employee not subject to the
workers’compensation law of any state
shown in Item 3.A.of the Information
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.
3.The bodily injury must occur in the United
States of America,its territories or
possessions,or Canada,and may occur
elsewhere if the employee is a United States
or Canadian citizen,or otherwise legal
resident,and legally employed,in the United
States or Canada and temporarily away from
those places.
4.Bodily injury by accident must occur during
the policy period.
5.Bodily injury by disease must be caused or
aggravated by the conditions of the
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 3 of 6
officer’s or employee’s employment.The
officer’s or employee’s last day of last
exposure to the conditions causing or
aggravating such bodily injury by disease
must occur during the policy period.
B.We Will Pay
We will pay an amount equal to the benefits
that would be required of you as if you and
your employees were subject to the workers’
compensation law of any state shown in Item
3.A.of the Information Page.We will pay
those amounts to the persons who would be
entitled to them under the law.
C.Exclusion
This insurance does not cover:
1.any obligation imposed by workers’
compensation or occupational disease
law or any similar law.
2.bodily injury intentionally caused or
aggravated by you.
3.officers or employees who have elected
not to be subject to the state workers’
compensation law.
4.partners or sole proprietors not covered
under the Standard Sole Proprietors,
Partners,Officers and Others Coverage
Endorsement.
D.Before We Pay
Before we pay benefits to the persons
entitled to them, they must:
1.Release you and us,in writing,of all
responsibility for the injury or death.
2.Transfer to us their right to recover from
others who may be responsible for the
injury or death.
3.Cooperate with us and do everything
necessary to enable us to enforce the
right to recover from others.
If the persons entitled to the benefits of this
insurance fail to do those things,our duty to
pay ends at once.If they claim damages
from you or from us for the injury or death,
our duty to pay ends at once.
E.Recovery From Others
If we make a recovery from others,we will
keep an amount equal to our expenses of
recovery and the benefits we paid.We will
pay the balance to the persons entitled to it.
If the persons entitled to the benefits of this
insurance make a recovery from others,they
must reimburse us for the benefits we paid them.
F.Employers’ Liability Insurance
Part Two (Employers’Liability Insurance)applies
to bodily injury covered by this endorsement as
though the State of Employment was shown in
Item 3.A. of the Information Page.
This provision 5.does not apply in New Jersey or
Wisconsin.
EMPLOYERS’ LIABILITY STOP GAP COVERAGE
6.Employers’ Liability Stop Gap Coverage
A.This coverage only applies in Montana,North
Dakota,Ohio,Washington,West Virginia and
Wyoming.
B.Part One (Workers’Compensation Insurance)
does not apply to work in states shown in
Paragraph A above.
C.Part Two (Employers’Liability Insurance)applies
in the states,shown in Paragraph A.,as though
they were shown in Item 3.A.of the Information
Page.
D.Part Two,Section C.Exclusions is changed by
adding these exclusions.
This insurance does not cover;
5.bodily injury intentionally caused or
aggravated by you or in Ohio bodily injury
resulting from an act which is determined by
an Ohio court of law to have been committed
by you with the belief than an injury is
substantially certain to occur.However,the
cost of defending such claims or suits in Ohio
is covered.
13.bodily injury sustained by any member of the
flying crew of any aircraft.
14.any claim for bodily injury with respect to
which you are deprived of any defense or
defenses or are otherwise subject to penalty
because of default in premium under the
provisions of the workers’compensation law
or laws of a state shown in Paragraph A.
E.This insurance applies to damages for which you
are liable under West Virginia Code Annot.S 23-
4-2.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 4 of 6
EXTENDED OPTIONS
1.Employers’ Liability Insurance
Item 3.B.of the Information Page is replaced by
the following:
B.Employers’ Liability Insurance:
1.Part Two of the policy applies to work in
each state listed in Item 3.A.
The Limits of Liability under Part Two are
the higher of:
Bodily Injury
by Accident $500,000 Each Accident
Bodily Injury
by Disease $500,000 Policy Limit
Bodily Injury
by Disease $500,000 Each Employee
OR
2.The amount shown in the Information
Page.
This provision 1 of EXTENDED OPTIONS does
not apply in New York because the Limits Of Our
Liability are unlimited.
In this provision the limits are changed from
$500,000 to $1,000,000 in California.
2.Unintentional Failure to Disclose Hazards
If you unintentionally should fail to disclose all
existing hazards at the inception date of your
policy,we shall not deny coverage under this
policy because of such failure.
3.Waiver of Our Right To Recover From Others
A.We have the right to recover our payments
from anyone liable for an injury covered by
this policy.We will not enforce our right
against any person or organization for whom
you perform work under a written contract
that requires you to obtain this agreement
from us.
This agreement shall not operate directly or
indirectly to benefit anyone not named in the
agreement.
B.This provision 3.does not apply in the states
of Pennsylvania and Utah.
4.Foreign Voluntary Compensation and Employers’
Liability Reimbursement
A.How This Reimbursement Applies
This reimbursement provision applies to bodily
injury by accident or bodily injury by disease.
Bodily injury includes resulting death.
1.The bodily injury must be sustained by an
officer or employee.
2.The bodily injury must occur in the course of
employment necessary or incidental to work
in a country not listed in Exclusion C.1.of this
provision.
3.Bodily injury by accident must occur during
the policy period.
4.Bodily injury by disease must be caused or
aggravated by the conditions of your
employment.The officer or employee’s last
exposure to those conditions of your
employment must occur during the policy
period.
B.We Will Reimburse
We will reimburse you for all amounts paid by
you whether such amounts are:
1.voluntary payments for the benefits that
would be required of you if you and your
officers or employees were subject to any
workers’compensation law of the state of
hire of the individual employee.
2.sums to which Part Two (Employers’Liability
Insurance)would apply if the Country of
Employment were shown in Item 3.A.of the
Information Page.
C.Exclusions
This insurance does not cover:
1.any occurrences in the United States,
Canada,and any country or jurisdiction
which is the subject of trade or economic
sanctions imposed by the laws or regulations
of the United States of America in effect as of
the inception date of this policy.
2.any obligation imposed by a workers’
compensation or occupational disease law,
or similar law.
3.bodily injury intentionally caused or
aggravated by you.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 5 of 6
4.liability for any consequence,whether
direct or indirect,of war,invasion,act of
Foreign enemy,hostilities (whether war
be declared or not),civil war,rebellion,
revolution,insurrection or military or
usurped power.No endorsement now or
subsequently attached to this policy shall
be construed as overriding or waiving
this limitation unless specific reference is
made thereto.
D.Before We Pay
Before we reimburse you for the benefits to
the persons entitled to them,you must have
them:
1.release you and us,in writing,of all
responsibility for the injury or death,
2.transfer to us their right to recover from
others who may be responsible for their
injury or death,
3.cooperate with us and do everything
necessary to enable us to enforce the
right to recover from others.
If the persons entitled to the benefits paid fail
to do these things,our duty to reimburse
ends at once.If they claim damages from us
for the injury or death,our duty to reimburse
ends at once.
E.Recovery From Others
If we make a recovery from others,we will
keep an amount equal to our expenses of
recovery and the benefits we reimbursed.
We will pay the balance to the persons
entitled to it.If persons entitled to the
benefits make a recovery from others,they
must repay us for the amounts that we have
reimbursed you.
F.Reimbursement for Actual Loss
Sustained
This endorsement provides only for
reimbursement for the loss you actually
sustain.In order for you to recover loss or
expenses under this reimbursement you
must:
1.actually sustain and pay the loss or
expense in money after trial, or
2.secure our consent for the payment of
the loss or expense.
G.Repatriation
Our reimbursement includes the additional
expenses of repatriation to the United States
of America necessarily incurred as a direct result
of bodily injury.
Our reimbursement shall be limited as follows:
1.to the amount by which such expenses
exceed the normal cost of returning the
officer or employee if in good health, or
2.in the event of death,to the amount by which
such expenses exceed the normal cost of
returning the officer or employee if alive and
in good health.
In no event shall our reimbursement exceed the
bodily injury by accident limit shown in Item 3.B.
of the Information Page as respects any one
such officer or employee whether dead or alive.
H.Endemic Disease
The word “disease”includes any endemic
diseases.
The coverage applies as if endemic diseases
were included in the provisions of the workers’
compensation law.
5.Longshore and Harbor Workers’Compensation
Act Coverage
General Section C.Workers’Compensation Law
is replaced by the following:
C.Workers’ Compensation Law
Workers’Compensation Law means the workers
or workers’compensation law and occupational
disease law of each state or territory named in
Item 3.A.of the Information Page and the
Longshore and Harbor Workers’Compensation
Act (33 USC Sections 901-950).It includes any
amendments to those laws that are in effect
during the policy period.It does not include any
other federal workers or workers’compensation
law,other federal occupational disease law or the
provisions of any law that provide
nonoccupational disability benefits.
Part Two (Employers’Liability Insurance),C.
Exclusions,exclusion 8,does not apply to work
subject to the Longshore and Harbor Workers’
Compensation Act.
This coverage does not apply to work subject to
the Defense Base Act,the Outer Continental
Shelf Lands Act,or the Nonappropriated Fund
Instrumentalities Act.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 6 of 6
SECTION III
1.SCHEDULE OF COVERED STATES
A.This endorsement only applies in the states
listed in this Schedule of Covered States.
B.If a state,shown in Item 3.A.of the Information
Page,approves this endorsement after the
effective date of this policy,this endorsement 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
Countersigned by
Authorized Representative
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DESIGN PROFESSIONAL SERVICES AGREEMENT (SINGLE)
WITH NATRON RESOURCES, INC
1. PARTIES
This Agreement is made by and between the City of Cupertino, a municipal corporation (“City”),
and Natron Resources, Inc (“Consultant”), a Corporation for Sports Center Fire Alarm System
Replacement (“Project”), and is effective on the last date signed below (“Effective Date”).
2. SERVICES
2.1 Basic Services. Consultant agrees to provide the Basic Services for the Project, which are set
forth in detail in the Scope of Services, attached here and incorporated as Exhibit A, and as further
specified in Consultant’s written Proposal as approved by City, except for any provision in the
Proposal which conflicts or is inconsistent with this Agreement and the Exhibits hereto, or as
otherwise expressly rejected by City. Consultant further agrees to carry out its work in compliance
with any applicable local, State, or Federal order regarding COVID-19.
2.2 Additional Services. City may request at any time during the Contract Time that Consultant
provide additional services for the Project, which are not already encompassed, expressly or implicitly,
in the Agreement, the Scope of Services, or the Proposal (“Additional Services”). Additional Services
must be authorized in writing by City and Consultant will not be paid for unauthorized Additional
Services rendered. Additional Services are subject to all the provisions applicable to Basic Services,
except and only to the extent otherwise specified by City in writing.
All references to “Services” in the Agreement include Basic Services and Additional Services, unless
otherwise stated in writing. The Services may be divided into separate sequential tasks, as further
specified in this Agreement, the Scope of Services, and Consultant’s Proposal.
Consultant is solely responsible for its errors and omissions and those of its subconsultants, and must
promptly correct them at its sole expense. Consultant must take appropriate measures to avoid or
mitigate any delay, liability, and costs resulting from its errors or omissions.
3. TIME OF PERFORMANCE
3.1 Term. This Agreement begins on the Effective Date and ends on June 30, 2022, unless
terminated earlier as provided herein (“Contract Time”). The City’s appropriate department head or
City Manager may extend the Contract Time through a written amendment to this Agreement,
provided such extension does not include additional contract funds. Extensions requiring additional
contract funds are subject to the City’s purchasing policy.
3.2 Schedule of Performance. All Services must be provided within the times specified in Exhibit
B, Schedule of Performance, attached and incorporated here. Consultant must promptly notify City of
any actual or potential delay in providing the Services as scheduled to afford the Parties adequate
opportunity to address or mitigate delays. If the Services are divided by tasks, Consultant must begin
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work on each separate task upon receiving City’s Notice to Proceed (“NTP”), and must complete each
task within the time specified in Exhibit B.
3.3 Time is of the essence for the performance of all the Services. Consultant must have sufficient
time, resources, and qualified staff to deliver the Services on time.
4. COMPENSATION
4.1 Maximum Compensation. City will pay Consultant for satisfactory performance of the Basic
Services and Additional Services, if approved, a cumulative total amount that will be capped so as not
to exceed $22,200.00 (“Contract Price”), as specified in Exhibit C, Compensation, attached and
incorporated here. The Contract Price includes all expenses and reimbursements and will remain in
place even if Consultant’s actual costs exceed the capped amount. No extra work or payment is
permitted in excess of the Contract Price.
4.2 Basic Services. City will pay Consultant $22,200.00 (“Lump Sum Price”) for the complete
and satisfactory performance of the Basic Services in accordance with Exhibit C. The Lump Sum Price
is inclusive of all time and expenses, including, but not limited to, sub-Consultants’ costs, materials,
supplies, equipment, travel, taxes, overhead, and profit. If the Basic Services are not fully completed,
Consultant will be compensated a percentage of the Lump Sum Price proportionate to the percentage
of Basic Services that were completed to City’s reasonable satisfaction.
4.3 Additional Services. City has the discretion, but not the obligation, to authorize Additional
Services up to an amount not to exceed $0.00 Additional Services provided to City’s reasonable
satisfaction will be compensated on a lump sum basis or based on time and expenses, in accordance
will the Hourly Rates and Reimbursable Expenses Schedules included in Exhibit C. If paid on an
hourly basis, Consultant will be compensated for actual costs only of normal business expenses and
overhead, with no markup or surcharge (“Reimbursable Expenses”). Consultant will not be entitled to
reimbursement for copying, printing, faxes, telephone charges, employee overtime, or travel to City
offices or to the Project site.
4.4 Invoices and Payments. Monthly invoices must describe the Services completed and the
Amount due for the preceding month. City will pay Consultant within thirty (30) days following
receipt of a properly submitted and approved invoice for Services. The invoice must separately itemize
and provide subtotals for Basic Services and Additional Services, and must state the percentage of
completion for each task, as specified in Exhibit C. City will notify Consultant in writing of any
disagreements with the invoice or the stated percentage of completion of tasks. If the disagreement is
unresolved, City will pay Consultant only for the undisputed portion of the Services. Disputed amounts
shall be subject to the Dispute Resolution provision of this Agreement.
a. Time and Expenses. For Additional Services provided on an hourly basis, each invoice
must also include, for each day of Services provided: (i) name and title of each person
providing Services; (ii) a succinct summary of the Services performed by each person;
(iii) the time spent per person, in thirty (30) minute increments; (iv) the hourly billing
rate or Sub- Consultant charge and payment due; and (v) an itemized list with amounts
and explanation for all permitted reimbursable expenses.
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b. Rates and Receipts. All hourly rates and reimbursable expenses must conform to the
City- approved rates set forth in Exhibit C, which will be in effect for the entire Contract
Time. Each invoice must attach legible, dated receipts for Reimbursable Expenses.
5. INDEPENDENT CONTRACTOR
5.1 Status. Consultant is an independent Consultant and not an employee, partner, or joint venture
of the City. Consultant is solely responsible for the means and methods of performing the Services
and shall exercise full control over the employment, direction, compensation and discharge of all
persons assisting Consultant in performing the Services. Consultant is not entitled to health benefits,
worker’s compensation, retirement, or any City benefit.
5.2 Qualifications and Standard of Care. Consultant represents on behalf of itself and its sub-
Consultants that they have the qualifications and skills to perform the Services in a competent and
professional manner, as exercised by design professionals performing similar services in the San
Francisco Bay Area. Services may only be performed by qualified and experienced personnel or
subconsultants who are not employed by City and do not have any contractual relationship with City
excepting this Agreement. All Services must be performed as specified to City’s reasonable satisfaction.
Nothing in the Agreement shall be interpreted to require Consultant to meet any higher standard of care,
and this paragraph shall control over any such contrary provision.
5.3 Permits and Licenses. Consultant warrants on behalf of itself and any sub-Consultants that
they are properly licensed, registered, and/or certified to perform the Services, as required by law, and
that they have procured a valid City Business License, if required by the Cupertino Municipal Code.
5.4 Sub-Consultants. Unless prior written approval from City is obtained, only Consultant’s
employees and sub-Consultants whose names are included in this Agreement and incorporated
Exhibits may provide Services under this Agreement. Consultant must require all sub-Consultants to
furnish proof of insurance for workers’ compensation, commercial liability, auto, and professional
liability in reasonable conformity to the insurance required of Consultant. The terms and conditions
of this Agreement shall be binding on all sub-Consultants relative to the portion of their work.
5.5 Tools, Materials, and Equipment. Consultant will supply and shall be responsible for all
tools, materials, and equipment required to perform the Services under this Agreement.
5.6 Payment of Benefits and Taxes. Consultant is solely responsible for the payment of
employment taxes incurred under this Agreement and any similar federal or state taxes. Consultant
and any of its employees, agents, and subcontractors shall not have any claim under this Agreement
or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off,
overtime, health insurance, medical care, hospital care, insurance benefits, social security,
disability, unemployment, workers compensation or employee benefits of any kind. Consultant
shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or
charges applicable to Consultant’s business including, but not limited to, federal and state income
taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf
of Consultant. Should any court, arbitrator, or administrative authority, including but not limited to
the California Public Employees Retirement System (PERS), the Internal Revenue Service or the
State Employment Development Division, determine that Consultant, or any of its employees,
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agents, or subcontractors, is an employee for any purpose, then Consultant agrees to a reduction in
amounts payable under this Agreement, or to promptly remint to City any payments due by the City
as a result of such determination, so that the City’s total expenses under this Agreement are not
greater than they would have been had the determination not been made.
5.7 Errors and Omissions. Consultant is solely responsible for its errors and omissions and
those of its sub-Consultants, and must take prompt measures to avoid, mitigate, and correct them at
its sole expense.
6. PROPRIETARY/CONFIDENTIAL INFORMATION
During the Contract Time, Consultant may have access to private or confidential information owned
or controlled by the City, which may contain proprietary or confidential details, the disclosure of
which to third parties may be damaging to City. Consultant shall hold in confidence all City
information and use it only to perform this Agreement. Consultant shall exercise the same standard of
care to protect City information as a reasonably prudent Consultant would use to protect its own
proprietary data.
7. OWNERSHIP OF MATERIALS
7.1 Property Rights. Subject to City meeting its payment obligations for the Services, any interest
(including copyright interests) of Consultant in any product, memoranda, study, report, map, plan,
drawing, specification, data, record, document, or other information or work, in any medium, prepared
by Consultant under this Agreement (“Work Product”), will be the exclusive property of the City upon
completion of the work to be performed hereunder or upon termination of this Agreement, to the
extent requested by City. In any case, no Work Product shall be shown to a third-party without prior
written approval by City
7.2 Copyright. To the extent permitted by Title 17 of the U.S. Code, all copyrights to the Work
Product prepared/created by Consultant and its sub-Consultants and all copyrights in such Work
Product shall constitute City property. If it is determined under federal law that the Work Product is
not “works for hire,” Consultant hereby assigns to City all copyrights to the Work Product when and
as created, and shall require sub-Consultants to do the same. Consultant may retain copyrights to its
standard details, but hereby grants City a perpetual, non-exclusive license to use such details.
7.3 Patents and Licenses. Consultant must pay royalties or license fees required for authorized
use of any third party intellectual property, including but not limited to patented, trademarked, or
copyrighted intellectual property if incorporated into the Services or Work Product of this Agreement.
7.4 Re-Use of Work Product. Unless prohibited by law and without waiving any rights, City may
use or modify the Work Product of Consultant and its sub-Consultants to execute or implement any of
the following, but Consultant shall not be responsible or liable for City’s re-use of Work Product:
(a) For work related to the original Services for which Consultant was hired;
(b) To complete the original Services with City personnel, agents or other Consultants;
(c) To make subsequent additions to the original Services; and/or
(d) For other City projects.
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7.5 Deliverables and Format. Electronic and hard copies of the Work Product constitute part of
the Deliverables required under this Agreement, which shall be provided to City on recycled paper and
copied on both sides, except for one single-sided original. Large-scale architectural plans and similar
items must be in CAD and PDF formats, and unless otherwise specified, other documents must be in
Microsoft Office applications and PDF formats.
8. RECORDS
8.1 Consultant must maintain complete, accurate, and detailed accounting records relating to the
Services and Compensation, in accordance with generally accepted accounting principles and
procedures. The records must include detailed information about Consultant’s performance,
benchmarks, and deliverables. The records and supporting documents must be kept separate from
other files and maintained for a period of four (4) years from the date of City’s final payment.
8.2 Consultant will provide City full access to Consultant’s books and records for review and
audit, to make transcripts or copies, and to conduct a preliminary examination of all the work, data,
documents, proceedings, and activities related to this Agreement. If a supplemental examination or
audit of Consultant’s records discloses non-compliance with appropriate internal financial controls, a
contract breach, or a failure to act in good faith, City will be entitled to recover from Consultant the
costs of the supplemental examination. If this is a lump sum fee Agreement, City will be provided
access to records of reimbursable expenses and the instruments of service/deliverables for review and
audit. This Section 8 survives the expiration/termination of this Agreement.
8.3 Consultant acknowledges that certain documents generated or received by Consultant in
connection with the performance of this Agreement, including but not limited to correspondence
between Consultant and any third party, are public records under the California Public Records Act,
California Government Code section 6250 et seq. Consultant shall comply with all laws regarding the
retention of public records and shall make such records available to the City upon request by the City,
or in such manner as the City reasonably directs that such records be provided.
9. ASSIGNMENT
Consultant shall not assign, sublease, hypothecate, or transfer this Agreement, or any interest therein,
directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any
attempt to do so will be null and void. Any changes related to the financial control or business nature
of Consultant as a legal entity will be considered an Assignment subject to City approval, which shall
not be unreasonably withheld. For purposes of this provision, control means fifty percent (50%) or
more of the voting power of the business entity. This Agreement binds Consultant, its heirs, successors
and assignees.
10. PUBLICITY / SIGNS
Any publicity generated by Consultant for the project under this Agreement, during the term of this
Agreement and for one (1) year thereafter, will reference the City’s contributions in making the
project possible. The words “City of Cupertino” will be displayed in all pieces of publicity, including
flyers, press releases, posters, brochures, public service announcements, interviews, and newspaper
articles. No signs may be posted, exhibited, or displayed on or about City property, except signage
required by law or this Agreement, without prior written approval from the City.
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11. INDEMNIFICATION
11.1 To the fullest extent allowed by law and except for losses caused by the sole or active
negligence or willful misconduct of City personnel, Consultant agrees to indemnify, defend, and hold
harmless the City as follows:
a. Indemnity for Design Professional Liability: With respect to the performance of
design professional services by a design professional as defined in California Civil Code Section
2782.8, to the fullest extent permitted by law, Consultant shall indemnify and hold harmless City, its
officers, officials, agents, employees, and volunteers (collectively and/or individually “City”) from
and against any and all liabilities, claims, damages, losses, costs, or expenses (including, without
limitation, costs, attorneys’ fees, and expert fees of litigation and alternative dispute resolution) of
every nature to the extent arising out of, pertaining to, or relating to the negligence, recklessness, or
willful misconduct of Consultant or any of its officers, employees, servants, agents, or subcontractors
(collectively and/or individually “Consultant”), in the performance of this Agreement or failure to
comply with any obligations of the Agreement. If it is finally determined (through a non-appealable
judgment or an agreement between City and Consultant) that liability is caused by the comparative
negligence or willful misconduct of City, then Consultant’s indemnification and hold harmless
obligation shall not exceed Consultant’s finally determined percentage of liability based upon the
comparative fault of Consultant.
Irrespective of any language to the contrary in this Agreement, the Consultant has no duty to provide
or to immediately pay for an up-front defense of City against unproven claims or allegations, but shall
reimburse those litigation costs and expenses (including, without limitation, attorneys’ fees, and expert
fees) incurred by the City to the extent caused by the negligence, recklessness, or willful misconduct
of Consultant. In no event shall the cost to defend charged to Consultant exceed Consultant’s
proportional percentage of fault, except as described in Section 2782.8(a) and (c) of the California
Civil Code.
b. Claims Involving Intellectual Property. Consultant shall indemnify, defend, and
hold harmless Indemnitees from and against any claim involving intellectual property,
infringement, or violation of a United States patent right or copyright, trade secret, trademark, or
service mark or other proprietary or intellectual property rights, which arises out of, pertains to, or
relates to Consultant’s negligence, recklessness, or willful misconduct. Such costs and expenses
will include reasonable attorney fees for legal counsel of City’s choice, expert fees, and all other
costs and fees of litigation.
c. Claims for Other Liability. Except as provided in subsections 11.1(a) and (b), to
the fullest extent permitted by law, Consultant shall hold harmless, defend (with counsel agreed to
by City), and indemnify City and its officers, officials, agents, employees, and volunteers
(collectively and/or individually “City”) from and against any and all liability, claim, loss, damage,
expense, costs (including, without limitation, costs, attorneys’ fees, and expert fees of litigation) of
every nature arising out of, related to, or in connection with the performance of work hereunder by
Consultant or any of its officers, employees, servants, agents, or subcontractors, or the failure of
the same to comply with any of the obligations contained in this Agreement, except such loss or
damage which was caused by the sole negligence or sole willful misconduct of the City.
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Consultant’s duty to defend applies immediately, whether or not liability is established. An allegation
or determination that persons other than Contractor are responsible for the claim does not relieve
Contractor from its separate and distinct obligation to defend as stated herein.
11.2 Consultant will assist City, at no additional cost, in the defense of any claim, dispute, or
lawsuit arising out of this Agreement. Consultant’s duties herein are not limited to or subject to the
Contract Price, to Workers’ Compensation claims, or to the Insurance or Bond limits and provisions.
Nothing in this Agreement shall be construed to give rise to an implied right of indemnity in favor of
Consultant against any Indemnitee.
11.3 Consultant agrees to pay the reasonable costs City may incur in enforcing this provision related
to Consultant’s indemnification duties, including reasonable attorney fees, fees for legal counsel
acceptable to City, expert fees, and all other costs and expenses related to a claim or counterclaim, a
purchase order, another transaction, litigation, or dispute resolution. Without waiving any rights, City
may deduct money from Consultant’s payments to cover moneys due to City.
11.4 Consultant agrees to obtain executed indemnity agreements with provisions identical to those
set forth here in this Section 11 from each and every subcontractor, or any other person or entity
involved by, for, with, or on behalf of Consultant in the performance of this Agreement. Failure of
City to monitor compliance with these requirements imposes no additional obligations on City and
will in no way act as a waiver of any rights hereunder.
11.5 This Section 11 shall survive expiration or termination of this Agreement.
12. INSURANCE
On or before the Contract Time commences, Consultant shall furnish City with proof of compliance
with City Insurance Requirements, attached and incorporated here as Exhibit D. City will not execute
the Agreement until Consultant has submitted and City has reasonably approved receipt of satisfactory
certificates of insurance and endorsements evidencing the type, amount, class of operations covered,
and the effective and expiration dates of coverage. Alternatively, City may terminate this Agreement or
in its sole discretion purchase insurance at Consultant’s expense and deduct costs from payments to
Consultant.
13. COMPLIANCE WITH LAWS
13.1 General Laws. Consultant shall comply with all laws, and regulations applicable to this
Agreement. Consultant will promptly notify City of changes in the law or other conditions that may
affect the Project or Consultant’s ability to perform. Consultant is responsible for verifying the
employment authorization of employees performing the Services, as required by the Immigration
Reform and Control Act, or other federal or state law, rule or regulation.
13.2 Labor Laws. Consultant shall comply with all labor laws applicable to this Agreement. If the
Services include a “public works” component, Consultant must comply with prevailing wage laws
under Labor Code Section 1720 and other labor laws. To the extent applicable, Consultant must
comply with City’s Labor Compliance Program and with state labor laws pertaining to working days,
overtime, payroll records and DIR Registration and Oversight. If the Contract Price is $30,000 or
more, Consultant must comply with the apprenticeship requirement in Labor Code Section 1777.5.
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13.3 Discrimination Laws. Consultant shall not discriminate on the basis of race, religious creed,
color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex,
gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS), or any
other protected classification. Consultant shall comply with all anti-discrimination laws, including
Government Code Section 12900 and 11135, and Labor Code Section. 1735, 1777, and 3077.5.
Consistent with City policy prohibiting it, Consultant understands that harassment and discrimination
by Consultant or any of its sub-Consultants toward a job applicant, an employee, a City employee, or
any other person is strictly prohibited. Consultant agrees to provide records and documentation to the
City on request necessary to monitor compliance with this provision.
13.4 Conflicts of Interest. Consultant shall comply with all conflict of interest laws and regulations
applicable to this Agreement and must avoid any conflict of interest. Consultant warrants that no
public official, employee, or member of a City board or commission who might have been involved in
the making of this Agreement, has or will receive a direct or indirect financial interest in this
Agreement in violation of California Government Code Section 1090 et seq. Consultant may be
required to file a conflict of interest form if Consultant makes certain governmental decisions or serves
in a staff capacity, as provided in Section 18700 of Title 2 of the California Code of Regulations and
other laws. Services may only be performed by persons who are not employed by City and who do not
have any contractual relationship with City, with the exception of this Agreement. Consultant is
familiar with and agrees to abide by the City’s rules governing gifts to public officials and employees.
13.5 Remedies. A violation of this Section 13 constitutes a material breach and may result in City
suspending payments, requiring reimbursement, or terminating this Agreement. City reserves all its
rights and remedies under law and this Agreement, including the right to seek indemnification under
Section 11. Consultant agrees to indemnify, defend, and hold City harmless from and against any loss,
liability, and expenses arising from noncompliance with this Section.
14. PROJECT COORDINATION
14.1 City Project Manager. The City’s Project Manager for all purposes under this Agreement will
be Ryan Do, who shall have the authority to manage this Agreement and oversee the progress and
performance of the Services. City in its sole discretion may substitute another Project Manager at any
time and will advise Consultant of the new representative.
14.2 Consultant Project Manager. Subject to City’s reasonable approval, Consultant’s Project
Manager for all purposes under this Agreement will be Jeff Ansley, President, who shall be the single
representative for Consultant with the authority to manage compliance with this Agreement and
oversee the progress and performance of the Services. This includes responsibility for coordinating and
scheduling the Services in accordance with City instructions, service orders, and the Schedule of
Performance, and providing regular updates to the City’s Project Manager on the Project status,
progress, and any delays. City written approval is required prior to Consultant substituting a new
Project Manager, which shall result in no additional costs to City or Project delays.
15. ABANDONMENT OF PROJECT
City may abandon or postpone the Project with thirty (30) calendar days written notice to Consultant.
Consultant will be compensated for satisfactory Services performed through the date of abandonment
and will be given reasonable time to assemble the work and close out the Services. No close out work
shall be conducted without City reasonable approval of closure costs, which may not exceed ten
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percent (10%) of the total time expended to the date of abandonment. All charges including job
closure costs will be paid in accordance with the provisions of this Agreement and within thirty (30)
days of Consultant’s final invoice reasonably approved by the City.
16. TERMINATION
City may terminate this Agreement for cause or without cause at any time, following reasonable
written notice to Consultant at least thirty (30) calendar days prior to the termination date. Consultant
will be paid for satisfactory Services rendered through the date of termination, but final payment will
not be made until Consultant closes out the Services and delivers all Work Product to City. All
charges approved by City including job closure costs will be paid within thirty (30) days of
Consultant’s final invoice.
17. GOVERNING LAW, VENUE, AND DISPUTE RESOLUTION
This Agreement is governed by the laws of the State of California, excepting any choice of law rules
which may direct the application of laws of another jurisdiction. Any lawsuits filed related to this
Agreement must be filed with the Superior Court for the County of Santa Clara, State of California.
Consultant must comply with the claims filing requirements under the Government Code prior to filing
a civil action in court against City. The Agreement and obligations of the parties are subject to all valid
laws, orders, rules, and regulations of the authorities having jurisdiction over this Agreement (or the
successors of those authorities). If a dispute arises, Consultant must continue to provide the Services
pending resolution of the dispute. If the Parties elect arbitration, the arbitrator’s award must be
supported by law and substantial evidence and include detailed written findings of law and fact. In the
event of any dispute between the parties related to this Agreement or this Project, the Parties agree to
first negotiate in good faith toward a resolution with participation by representatives of each Party
holding sufficient authority to resolve the dispute. If such dispute cannot be resolved in this manner,
before any action or litigation is initiated other than as required to secure lien rights, the dispute shall
be submitted to mediation using the American Arbitration Association or another mediator as mutually
selected by the Parties. Such mediation shall be completed within a reasonable period of time
following either Party’s written demand with each Party to bear an equal share of the mediation fees
and its own respective attorney and consultant fees and costs.
18. THIRD PARTY BENEFICIARIES
There are no intended third party beneficiaries of this Agreement.
19. WAIVER
Neither acceptance of the Services nor payment thereof shall constitute a waiver of any contract
provision. City’s waiver of any breach shall not be deemed to constitute waiver of another term,
provision, covenant, or condition or a subsequent breach, whether of the same or a different character
20. ENTIRE AGREEMENT
This Agreement represents the full and complete understanding of the Parties, of every kind or nature,
and supersedes any and all other agreements and understandings, either oral or written,
between them. Any modification of this Agreement will be effective only if in writing and signed by
each Party’s authorized representative. No verbal agreement or implied covenant will be valid to amend
Sports Center Fire Alarm System Replacement
10 of 11
Design Professional Agr (Single) / October 2021
or abridge this Agreement. If there is any inconsistency between any term, clause, or provision of this
main Agreement and any term, clause, or provision of the attachments or exhibits thereto, the terms of
the main Agreement shall prevail and be controlling.
21. INSERTED PROVISIONS
Each contractual provision or clause that may be required by law is deemed to be included and will be
inferred in this Agreement. Either party may request an amendment to cure any mistaken insertion or
omission of a required provision.
22. HEADINGS
The headings in this Agreement are for convenience only, are not a part of the Agreement and in no
way affect, limit, or amplify the terms or provisions of this Agreement.
23. SEVERABILITY/PARTIAL INVALIDITY
If any term or provision of this Agreement, or their application to a particular situation, is found by the
court to be void, invalid, illegal or unenforceable, such term or provision shall remain in force and
effect to the extent allowed by such ruling. All other terms and provisions of this Agreement or their
application to specific situations shall remain in full force and effect.
24. SURVIVAL
All provisions which by their nature must continue after the Agreement ends, including without
limitation those referenced in specific Sections herein, survive this Agreement and shall remain in full
force and effect.
25. NOTICES
All notices, requests, and approvals must be sent to the persons below in writing to the persons
below, and will be considered effective on the date of personal delivery, the delivery date confirmed
by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States
Mail, postage prepaid, registered or certified, or the next business day following electronic
submission:
To City of Cupertino:
Office of the City Manager
10300 Torre Ave.
Cupertino, CA 95014
Attention: Ryan Do
Email: RyanD@cupertino.org
To Consultant:
Natron Resources, Inc
1480 Moraga Rd., Suite C #229,
Moraga, CA 94556
Attention: Jeff Ansley, President
Email: jeff@natronresources.com
26. EXECUTION
The person executing this Agreement on behalf of Consultant represents and warrants that Consultant
has the right, power, and authority to enter into this Agreement and carry out all actions herein, and
Sports Center Fire Alarm System Replacement
11 of 11
Design Professional Agr (Single) / October 2021
that he or she is authorized to execute this Agreement, which constitutes a legally binding obligation of
Consultant. This Agreement may be executed in counterparts, each one of which is deemed an original
and all of which, taken together, constitute a single binding instrument.
IN WITNESS WHEREOF, the parties have caused the Agreement to be executed on the Effective
Date stated earlier in this Agreement.
CITY OF CUPERTINO NATRON RESOURCES, INC
A Municipal Corporation
By
Name
Title
Date
By
Name
Title
Date
APPROVED AS TO FORM:
CHRISTOPHER D. JENSEN
Cupertino City Attorney
ATTEST:
KIRSTEN SQUARCIA
City Clerk
Date
Oscar Louie
Senior Electrical Engineer
Jan 31, 2022
Christopher D. Jensen
Susan Michael
Susan Michael
CIP Manager
Jan 31, 2022
Jan 31, 2022
Cupertino Sports Courts Page 1
September 16, 2021
Revised October 8, 2021
Revised October 20, 2021
Jimmy Tan, P.E.
Assistant Director of Public Works - Operations
Public Works
jimmyt@cupertino.org
(408)777-3248
Re: Fire Alarm System upgrade/replacement at Cupertino Sports Facility,
21111 Stevens Creek Blvd.
Dear Jimmy:
We propose to furnish the necessary electrical engineering services, in connection with
the referenced project, for a Not to Exceed fee in the amount of $22,200.00 (twenty
thousand two hundred dollars and no cents), plus normal reimbursable expenses.
The Fees- are broken down as follows:
Site survey of existing conditions $2,000.00
65% plans and specifications $5,600.00
100% plans and specifications $5,600.00
Addendum $1,000.00
Bid $2,000.00
Construction Administration $5,000.00
As builts $1,000.00
Total Not to Exceed Fee $22,200.00
Excluding reimbursable
Scope of Electrical Work:
1.Field investigation of the existing fire alarm system serving sports facility.
2.New Fire Alarm Panel design and devices to replace existing system. Provide
coordination with Fire Marshall for approval of plans (city to provide a point of
contact).
3.Preparation of plans, specifications. The drawings and specs will be submitted
for 65% and 100% phases. The specifications shall be provided in word and the
drawings will be done in ACAD 2019.
4.Included in the scope is an allowance for one addendum after the approval of the
100% submittal.
5.During construction phase, work will be limited to submittal reviews, responses
to RFIs, office consultation, preconstruction meeting, one inspection during
construction, and one final inspection.
6.Provide As-built or record drawings based on contractor’s mark ups.
7.
Exhibits A, B, C
Cupertino Sports Courts Page 2
Additional Services:
Work that is not included in our Basic Services is considered additional service, billable
on an hourly basis when authorized in writing, and shall include:
1. Additional site meetings, except what is in the basic scope.
2. Addendums beyond what is stated in the scope.
An alternative to the above complete design, we can provide a performance
specification and documentation for a design built option. This would be a not to
exceed amount of $8,000.00 (eight thousand dollars and no cents) excluding any
reimbursables.
Should there be no exceptions to the above, please indicate your acceptance by signing
this letter where indicated below your selection and returning one copy to me.
Please call me should you have any questions.
Sincerely,
NATRON RESOURCES, INC.
Sincerely yours,
President, PE
510-847-9041
Accepted by City of Cupertino, this __________ day of ________________, 2021
By: __________________________________________________
Name/Title
Full Design Option ____________________
Design Built Option ____________________
Exh. D-Insurance Requirements for Design Professionals & Consultants Contracts
1
Form Updated Sept. 2019
Consultant shall procure prior to commencement of Services and maintain for the duration of the contract, at
its own cost and expense, the following insurance policies and coverage with companies doing business in
California and acceptable to City.
INSURANCE POLICIES AND MINIMUMS REQUIRED
1. Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for
premises operations, products and completed operations, contractual liability, and personal and
advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a
general aggregate limit applies, either the general aggregate limit shall apply separately to this
project/location (ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrence limit.
a. It shall be a requirement that any available insurance proceeds broader than or in excess of the
specified minimum insurance coverage requirements and/or limits shall be made available to the
Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the
broader coverage and maximum limits of coverage of any insurance policy, whichever is greater.
b. Additional Insured coverage under Consultant's policy shall be "primary and non-contributory,"
will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO
Form CG 20 10 (04/13).
c. The limits of insurance required may be satisfied by a combination of primary and umbrella or
excess insurance, provided each policy complies with the requirements set forth in this Contract. Any
umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage
shall also apply on a primary basis for the benefit of City before the City’s own insurance or self-
insurance shall be called upon to protect City as a named insured.
2. Automobile Liability: ISO CA 00 01 covering any auto (including owned, hired, and non-owned
autos) with limits no less than $1,000,000 per accident for bodily injury and property damage.
3. Workers’ Compensation: As required by the State of California, with Statutory Limits and Employer’s
Liability Insurance of no less than $1,000,000 per occurrence for bodily injury or disease.
Not required. Consultant has provided written verification of no employees.
4. Professional Liability for professional acts, errors and omissions, as appropriate to Consultant’s
profession, with limits no less than $2,000,000 per occurrence or $2,000,000 aggregate. If written on a
claims made form:
a. The Retroactive Date must be shown and must be before the Effective Date of the Contract.
b. Insurance must be maintained for at least five (5) years after completion of the Services.
c. If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with
a Retroactive Date prior to the Contract Effective Date, the Consultant must purchase “extended
reporting” coverage for a minimum of five (5) years after completion of the Services.
OTHER INSURANCE PROVISIONS
The aforementioned insurance shall be endorsed and have all the following conditions and provisions:
EXHIBIT D
Insurance Requirements
Design Professionals & Consultants Contracts
Exh. D-Insurance Requirements for Design Professionals & Consultants Contracts
2
Form Updated Sept. 2019
Additional Insured Status
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers
(“Additional Insureds”) are to be covered as additional insureds on Consultant’s CGL and automobile
liability policies. General Liability coverage can be provided in the form of an endorsement to Consultant’s
insurance (at least as broad as ISO Form CG 20 10 (11/ 85) or both CG 20 10 and CG 20 37 forms, if later
editions are used).
Primary Coverage
Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance
maintained by City, its officers, officials, employees, or volunteers shall be excess of Consultant’s insurance
and shall not contribute to it.
Notice of Cancellation
Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written
notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums.
Waiver of Subrogation
Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the
extent said losses are covered by the insurance policies required herein. Specifically, the Workers’
Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed
by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not
the City has received a waiver of subrogation endorsement from the insurer.
Deductibles and Self-Insured Retentions
Any deductible or self-insured retention must be declared to and approved by the City. At City’s option, either:
the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional
Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim
administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self-insured
retention may be satisfied by either the insured or the City.
Acceptability of Insurers
Insurers must be licensed to do business in California with an A.M. Best Rating of A-VII, or better.
Verification of Coverage
Consultant must furnish acceptable insurance certificates and mandatory endorsements (or copies of the policies
effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the
CGL policy listing all policy endorsements prior 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 naming the City as an additional insured on subconsultant’s insurance policies.
Higher Insurance Limits
If Consultant maintains broader coverage and/or higher limits than the minimums shown above, City shall be
entitled to coverage for the higher insurance limits maintained by Consultant.
Adequacy of Coverage
City reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior
experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:CONTACT
(A/C, No):FAX
E-MAILADDRESS:
PRODUCER
(A/C, No, Ext):PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$
$
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
EROTH-STATUTEPER
LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED $PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
11/23/2021
AssuredPartners Design Professionals Insurance Services,LLC
3697 Mt.Diablo Blvd Suite 230
Lafayette CA 94549
The Certificate Team
CertsDesignPro@AssuredPartners.com
License#:6003745 Sentinel Insurance Company 11000
NATRRES-01 Travelers Property Casualty Company of America 25674NatronResources,Inc.
1480 Moraga Rd,Ste C 229
Moraga CA 94556
Hartford Accident and Indemnity Company 22357
32894853
A X 2,000,000
X 1,000,000
X Contractual Liab 10,000
Included 2,000,000
4,000,000
X X
Y Y 57SBWBM8201 6/29/2021 6/29/2022
4,000,000
A 2,000,000
X X
X NoOwnedAutos
Y Y 57SBWBM8201 6/29/2021 6/29/2022
C XY57WEGZR17866/16/2021 6/16/2022
1,000,000
1,000,000
1,000,000
B Professional Liability 105637491 6/22/2021 6/22/2022 Per Claim
Aggregate Limit
$2,000,000
$2,000,000
Insured owns no company vehicles;therefore,hired/non-owned auto is the maximum coverage that applies.
RE:Project:Cupertino Sports Center Fire Panel
The City of Cupertino,its City Council,officers,officials,employees,agents,servants and volunteers are named as additional insureds as respects general
liability as required per written contract or agreement.General Liability is Primary/Non-Contributory per policy form wording.Insurance coverage includes waiver
of subrogation per the attached endorsement(s).
30 Day Notice of Cancellation
City of Cupertino
10300 Torre Ave
Cupertino CA 95014
ABCDEFGHIJ
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT - AGGREGATE LIMITS (PER PROJECT)
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
A. D.4.Section LIABILITY AND MEDICAL EXPENSES If the applicable “project” has been abandoned,
LIMITS OF INSURANCE is amended as follows:delayed, or abandoned and then restarted, or if
the authorized contracting parties deviate from1.D.The General Aggregate Limit under Section
plans, blueprints, designs, specifications orLIABILITY AND MEDICAL EXPENSES LIMIT
timetables, the “project” will still be deemed toOF INSURANCE applies separately to each of
be the same “project”.your "projects".
5.D.The provisions of Section LIABILITY AND2.The limits shown in the Declarations for Liability
MEDICAL EXPENSES LIMIT OF INSURANCEand Medical Expenses, Damage To Premises
not otherwise modified by this endorsementRented To You and Medical Expenses continue
shall continue to apply as stipulated.to apply.
B.Additional Definitions3.When coverage for liability arising out of the
G.“products-completed operations hazard” is The following definition is added to Section
provided, any payments for damages because LIABILITY AND MEDICAL EXPENSES
of “bodily injury” or “property damage” included DEFINITIONS:
in the “products-completed operations hazard”1.“Project” means “your work” at location(s) away
will reduce the Products-Completed Operations from premises owned or rented to you.
Aggregate Limit, and not reduce the General
Aggregate Limit.
Form SS 04 33 04 05 Page 1 of 1
© 2005, The Hartford
Policy #57SBWBM8201
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Form SS 51 14 04 17 Page 1 of 1
© 2017, The Hartford
ADDITIONAL INSURED PROVISIONS - CALIFORNIA
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
A.It is agreed that paragraph (2)of subsections 6.d.
and 6.f.of Section C. - WHO IS AN INSURED is
replaced by the following:
(2)The insurance afforded by paragraph (1)above
does not apply if your acts or omissions, or the
acts or omissions of those acting on your behalf,
that are alleged to have caused the "bodily
injury", "property damage" or "personal and
advertising injury", involve professional
architectural, engineering or surveying services,
including but not limited to:
(a)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;
(b)Supervisory, inspection, quality control,
architectural, engineering or surveying
activities or services;
(c)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;
(d)Monitoring, sampling, or testing service
necessary to perform any of the services
included in a. b. or c. above;
(e)Supervision, hiring, employment, training or
monitoring of others who are performing
any of the services included in a., b. or c.
above.
The insurance afforded to such additional
insured:
(a)Only applies to the extent permitted by law;
and
(b)Will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B.It is agreed that the following paragraphs are added
to the end of subsections 1.and 8.of Section F -
OPTIONAL ADDITIONAL INSURED
COVERAGES;and it is agreed the following
paragraphs replace section b.of subsection 9.of
Section F. - OPTIONAL ADDITIONAL INSURED
COVERAGES.These paragraphs do not attach or
amend the language of any of the other subsections
of Section F - OPTIONAL ADDITIONAL INSURED
COVERAGES:
The insurance afforded by this subsection does not
apply if your acts or omissions, or the acts or
omissions of those acting on your behalf, that are
alleged to have caused the "bodily injury", "property
damage" or "personal and advertising injury",
involve professional architectural, engineering or
surveying services, including but not limited to:
(a)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;
(b)Supervisory, inspection, quality control,
architectural, engineering or surveying
activities or services;
(c)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;
(d)Monitoring, sampling, or testing service
necessary to perform any of the services
included in a. b. or c. above;
(e)Supervision, hiring, employment, training or
monitoring of others who are performing any
of the services included in a., b. or c. above.
The insurance afforded to such additional insured:
(a)Only applies to the extent permitted by law;
and
(b)Will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
Policy #57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
Form SS 00 08 04 05 Page 11 of 24
(b)Rented to, in the care, custody or
control of, or over which physical
control is being exercised for any
purpose by you, any of your
"employees", "volunteer workers",
any partner or member (if you are
a partnership or joint venture), or
any member (if you are a limited
liability company).
b. Real Estate Manager
Any person (other than your "employee" or
"volunteer worker"), or any organization
while acting as your real estate manager.
c. Temporary Custodians Of Your
Property
Any person or organization having proper
temporary custody of your property if you
die, but only:
(1)With respect to liability arising out of the
maintenance or use of that property; and
(2)Until your legal representative has
been appointed.
d. Legal Representative If You Die
Your legal representative if you die, but
only with respect to duties as such. That
representative will have all your rights and
duties under this insurance.
e. Unnamed Subsidiary
Any subsidiary and subsidiary thereof, of
yours which is a legally incorporated entity
of which you own a financial interest of
more than 50% of the voting stock on the
effective date of this Coverage Part.
The insurance afforded herein for any
subsidiary not shown in the Declarations
as a named insured does not apply to
injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an insured under such policy but for its
termination or upon the exhaustion of its
limits of insurance.
3. Newly Acquired Or Formed Organization
Any organization you newly acquire or form,
other than a partnership, joint venture or
limited liability company, and over which you
maintain financial interest of more than 50% of
the voting stock, will qualify as a Named
Insured if there is no other similar insurance
available to that organization. However:
a.Coverage under this provision is afforded
only until the 180th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier; and
b.Coverage under this provision does not
apply to:
(1)"Bodily injury" or "property damage"
that occurred; or
(2)"Personal and advertising injury"
arising out of an offense committed
before you acquired or formed the
organization.
4. Operator Of Mobile Equipment
With respect to "mobile equipment" registered in
your name under any motor vehicle registration
law, any person is an insured while driving such
equipment along a public highway with your
permission. Any other person or organization
responsible for the conduct of such person is
also an insured, but only with respect to liability
arising out of the operation of the equipment, and
only if no other insurance of any kind is available
to that person or organization for this liability.
However, no person or organization is an insured
with respect to:
a."Bodily injury" to a co-"employee" of the
person driving the equipment; or
b."Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
5. Operator of Nonowned Watercraft
With respect to watercraft you do not own that
is less than 51 feet long and is not being used
to carry persons for a charge, any person is an
insured while operating such watercraft with
your permission. Any other person or
organization responsible for the conduct of
such person is also an insured, but only with
respect to liability arising out of the operation
of the watercraft, and only if no other
insurance of any kind is available to that
person or organization for this liability.
However, no person or organization is an
insured with respect to:
a."Bodily injury" to a co-"employee" of the
person operating the watercraft; or
b."Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
6. Additional Insureds When Required By
Written Contract, Written Agreement Or
Permit
The person(s) or organization(s) identified in
Paragraphs a.through f.below are additional
insureds when you have agreed, in a written
Policy #
57SBWBM8201
57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
Page 12 of 24 Form SS 00 08 04 05
contract, written agreement or because of a
permit issued by a state or political
subdivision, that such person or organization
be added as an additional insured on your
policy, provided the injury or damage occurs
subsequent to the execution of the contract or
agreement, or the issuance of the permit.
A person or organization is an additional
insured under this provision only for that
period of time required by the contract,
agreement or permit.
However, no such person or organization is an
additional insured under this provision if such
person or organization is included as an
additional insured by an endorsement issued
by us and made a part of this Coverage Part,
including all persons or organizations added
as additional insureds under the specific
additional insured coverage grants in Section
F.– Optional Additional Insured Coverages.
a. Vendors
Any person(s) or organization(s) (referred to
below as vendor), but only with respect to
"bodily injury" or "property damage" arising
out of "your products" which are distributed
or sold in the regular course of the vendor's
business and only if this Coverage Part
provides coverage for "bodily injury" or
"property damage" included within the
"products-completed operations hazard".
(1)The insurance afforded to the vendor
is subject to the following additional
exclusions:
This insurance does not apply to:
(a)"Bodily injury" or "property
damage" for which the vendor is
obligated to pay damages by
reason of the assumption of
liability in a contract or agreement.
This exclusion does not apply to
liability for damages that the
vendor would have in the absence
of the contract or agreement;
(b)Any express warranty
unauthorized by you;
(c)Any physical or chemical change
in the product made intentionally
by the vendor;
(d)Repackaging, except when
unpacked solely for the purpose of
inspection, demonstration, testing,
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the
original container;
(e)Any failure to make such
inspections, adjustments, tests or
servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products;
(f)Demonstration, installation,
servicing or repair operations,
except such operations performed
at the vendor's premises in
connection with the sale of the
product;
(g)Products which, after distribution
or sale by you, have been labeled
or relabeled or used as a
container, part or ingredient of any
other thing or substance by or for
the vendor; or
(h)"Bodily injury" or "property
damage" arising out of the sole
negligence of the vendor for its
own acts or omissions or those of
its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(i)The exceptions contained in
Subparagraphs (d)or (f); or
(ii)Such inspections, adjustments,
tests or servicing as the vendor
has agreed to make or normally
undertakes to make in the usual
course of business, in
connection with the distribution
or sale of the products.
(2)This insurance does not apply to any
insured person or organization from
whom you have acquired such products,
or any ingredient, part or container,
entering into, accompanying or
containing such products.
b. Lessors Of Equipment
(1)Any person or organization from
whom you lease equipment; but only
with respect to their liability for "bodily
injury", "property damage" or
"personal and advertising injury"
caused, in whole or in part, by your
maintenance, operation or use of
equipment leased to you by such
person or organization.
Policy #
57SBWBM8201
57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
Form SS 00 08 04 05 Page 13 of 24
(2)With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to any
"occurrence" which takes place after
you cease to lease that equipment.
c. Lessors Of Land Or Premises
(1)Any person or organization from
whom you lease land or premises, but
only with respect to liability arising out
of the ownership, maintenance or use
of that part of the land or premises
leased to you.
(2)With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a)Any "occurrence" which takes
place after you cease to lease that
land or be a tenant in that
premises; or
(b)Structural alterations, new
construction or demolition
operations performed by or on
behalf of such person or
organization.
d. Architects, Engineers Or Surveyors
(1)Any architect, engineer, or surveyor, but
only with respect to liability for "bodily
injury", "property damage" or "personal
and advertising injury" caused, in whole
or in part, by your acts or omissions or
the acts or omissions of those acting on
your behalf:
(a)In connection with your premises;
or
(b)In the performance of your
ongoing operations performed by
you or on your behalf.
(2)With respect to the insurance afforded
to these additional insureds, the
following additional exclusion applies:
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
services by or for you, including:
(a)The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b)Supervisory, inspection,
architectural or engineering
activities.
e. Permits Issued By State Or Political
Subdivisions
(1)Any state or political subdivision, but
only with respect to operations
performed by you or on your behalf for
which the state or political subdivision
has issued a permit.
(2)With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a)"Bodily injury", "property damage"
or "personal and advertising
injury" arising out of operations
performed for the state or
municipality; or
(b)"Bodily injury" or "property damage"
included within the "products-
completed operations hazard".
f. Any Other Party
(1)Any other person or organization who
is not an insured under Paragraphs a.
through e. above, but only with
respect to liability for "bodily injury",
"property damage" or "personal and
advertising injury" caused, in whole or
in part, by your acts or omissions or
the acts or omissions of those acting
on your behalf:
(a)In the performance of your
ongoing operations;
(b)In connection with your premises
owned by or rented to you; or
(c)In connection with "your work" and
included within the "products-
completed operations hazard", but
only if
(i)The written contract or written
agreement requires you to
provide such coverage to
such additional insured; and
(ii)This Coverage Part provides
coverage for "bodily injury" or
"property damage" included
within the "products-
completed operations hazard".
(2)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:
Policy #
57SBWBM8201
57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
Page 14 of 24 Form SS 00 08 04 05
(a)The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b)Supervisory, inspection,
architectural or engineering
activities.
The limits of insurance that apply to additional
insureds are described in Section D.– Limits
Of Insurance.
How this insurance applies when other
insurance is available to an additional insured
is described in the Other Insurance Condition
in Section E.– Liability And Medical Expenses
General Conditions.
No person or organization is an insured with
respect to the conduct of any current or past
partnership, joint venture or limited liability
company that is not shown as a Named Insured in
the Declarations.
D. LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE
1. The Most We Will Pay
The Limits of Insurance shown in the
Declarations and the rules below fix the most
we will pay regardless of the number of:
a.Insureds;
b.Claims made or "suits" brought; or
c.Persons or organizations making claims or
bringing "suits".
2. Aggregate Limits
The most we will pay for:
a.Damages because of "bodily injury" and
"property damage" included in the
"products-completed operations hazard" is
the Products-Completed Operations
Aggregate Limit shown in the
Declarations.
b.Damages because of all other "bodily
injury", "property damage" or "personal
and advertising injury", including medical
expenses, is the General Aggregate Limit
shown in the Declarations.
This General Aggregate Limit applies
separately to each of your "locations"
owned by or rented to you.
"Location" means premises involving the
same or connecting lots, or premises
whose connection is interrupted only by a
street, roadway or right-of-way of a
railroad.
This General Aggregate limit does not
apply to "property damage" to premises
while rented to you or temporarily
occupied by you with permission of the
owner, arising out of fire, lightning or
explosion.
3. Each Occurrence Limit
Subject to 2.a.or 2.b above, whichever
applies, the most we will pay for the sum of all
damages because of all "bodily injury",
"property damage" and medical expenses
arising out of any one "occurrence" is the
Liability and Medical Expenses Limit shown in
the Declarations.
The most we will pay for all medical expenses
because of "bodily injury" sustained by any
one person is the Medical Expenses Limit
shown in the Declarations.
4. Personal And Advertising Injury Limit
Subject to 2.b.above, the most we will pay for
the sum of all damages because of all
"personal and advertising injury" sustained by
any one person or organization is the Personal
and Advertising Injury Limit shown in the
Declarations.
5. Damage To Premises Rented To You Limit
The Damage To Premises Rented To You
Limit is the most we will pay under Business
Liability Coverage for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
lightning or explosion, while rented to you or
temporarily occupied by you with permission of
the owner.
In the case of damage by fire, lightning or
explosion, the Damage to Premises Rented To
You Limit applies to all damage proximately
caused by the same event, whether such
damage results from fire, lightning or explosion
or any combination of these.
6. How Limits Apply To Additional Insureds
The most we will pay on behalf of a person or
organization who is an additional insured
under this Coverage Part is the lesser of:
a.The limits of insurance specified in a
written contract, written agreement or
permit issued by a state or political
subdivision; or
b.The Limits of Insurance shown in the
Declarations.
Such amount shall be a part of and not in
addition to the Limits of Insurance shown in
the Declarations and described in this Section.
Policy #
57SBWBM8201
57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
Form SS 00 08 04 05 Page 15 of 24
If more than one limit of insurance under this
policy and any endorsements attached thereto
applies to any claim or "suit", the most we will pay
under this policy and the endorsements is the
single highest limit of liability of all coverages
applicable to such claim or "suit". However, this
paragraph does not apply to the Medical Expenses
limit set forth in Paragraph 3.above.
The Limits of Insurance of this Coverage Part apply
separately to each consecutive annual period and to
any remaining period of less than 12 months, starting
with the beginning of the policy period shown in the
Declarations, unless the policy period is extended
after issuance for an additional period of less than 12
months. In that case, the additional period will be
deemed part of the last preceding period for purposes
of determining the Limits of Insurance.
E. LIABILITY AND MEDICAL EXPENSES
GENERAL CONDITIONS
1. Bankruptcy
Bankruptcy or insolvency of the insured or of
the insured's estate will not relieve us of our
obligations under this Coverage Part.
2. Duties In The Event Of Occurrence,
Offense, Claim Or Suit
a. Notice Of Occurrence Or Offense
You or any additional insured must see to
it that we are notified as soon as
practicable of an "occurrence" or an
offense which may result in a claim. To
the extent possible, notice should include:
(1)How, when and where the "occurrence"
or offense took place;
(2)The names and addresses of any
injured persons and witnesses; and
(3)The nature and location of any injury
or damage arising out of the
"occurrence" or offense.
b. Notice Of Claim
If a claim is made or "suit" is brought
against any insured, you or any additional
insured must:
(1)Immediately record the specifics of the
claim or "suit" and the date received;
and
(2)Notify us as soon as practicable.
You or any additional insured must see to
it that we receive a written notice of the
claim or "suit" as soon as practicable.
c. Assistance And Cooperation Of The
Insured
You and any other involved insured must:
(1)Immediately send us copies of any
demands, notices, summonses or
legal papers received in connection
with the claim or "suit";
(2)Authorize us to obtain records and
other information;
(3)Cooperate with us in the investigation,
settlement of the claim or defense
against the "suit"; and
(4)Assist us, upon our request, in the
enforcement of any right against any
person or organization that may be
liable to the insured because of injury
or damage to which this insurance
may also apply.
d. Obligations At The Insured's Own Cost
No insured will, except at that insured's own
cost, voluntarily make a payment, assume
any obligation, or incur any expense, other
than for first aid, without our consent.
e. Additional Insured's Other Insurance
If we cover a claim or "suit" under this
Coverage Part that may also be covered
by other insurance available to an
additional insured, such additional insured
must submit such claim or "suit" to the
other insurer for defense and indemnity.
However, this provision does not apply to
the extent that you have agreed in a
written contract, written agreement or
permit that this insurance is primary and
non-contributory with the additional
insured's own insurance.
f. Knowledge Of An Occurrence, Offense,
Claim Or Suit
Paragraphs a.and b.apply to you or to
any additional insured only when such
"occurrence", offense, claim or "suit" is
known to:
(1)You or any additional insured that is
an individual;
(2)Any partner, if you or an additional
insured is a partnership;
(3)Any manager, if you or an additional
insured is a limited liability company;
(4)Any "executive officer" or insurance
manager, if you or an additional
insured is a corporation;
(5)Any trustee, if you or an additional
insured is a trust; or
(6)Any elected or appointed official, if you
or an additional insured is a political
subdivision or public entity.
Policy #
57SBWBM8201
57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
Page 16 of 24 Form SS 00 08 04 05
This Paragraph f.applies separately to
you and any additional insured.
3. Financial Responsibility Laws
a.When this policy is certified as proof of
financial responsibility for the future under
the provisions of any motor vehicle
financial responsibility law, the insurance
provided by the policy for "bodily injury"
liability and "property damage" liability will
comply with the provisions of the law to
the extent of the coverage and limits of
insurance required by that law.
b.With respect to "mobile equipment" to
which this insurance applies, we will
provide any liability, uninsured motorists,
underinsured motorists, no-fault or other
coverage required by any motor vehicle
law. We will provide the required limits for
those coverages.
4. Legal Action Against Us
No person or organization has a right under
this Coverage Form:
a.To join us as a party or otherwise bring us
into a "suit" asking for damages from an
insured; or
b.To sue us on this Coverage Form unless
all of its terms have been fully complied
with.
A person or organization may sue us to recover
on an agreed settlement or on a final judgment
against an insured; but we will not be liable for
damages that are not payable under the terms of
this insurance or that are in excess of the
applicable limit of insurance. An agreed
settlement means a settlement and release of
liability signed by us, the insured and the
claimant or the claimant's legal representative.
5. Separation Of Insureds
Except with respect to the Limits of Insurance,
and any rights or duties specifically assigned
in this policy to the first Named Insured, this
insurance applies:
a.As if each Named Insured were the only
Named Insured; and
b.Separately to each insured against whom
a claim is made or "suit" is brought.
6. Representations
a. When You Accept This Policy
By accepting this policy, you agree:
(1)The statements in the Declarations
are accurate and complete;
(2)Those statements are based upon
representations you made to us; and
(3)We have issued this policy in reliance
upon your representations.
b. Unintentional Failure To Disclose
Hazards
If unintentionally you should fail to disclose
all hazards relating to the conduct of your
business at the inception date of this
Coverage Part, we shall not deny any
coverage under this Coverage Part
because of such failure.
7. Other Insurance
If other valid and collectible insurance is
available for a loss we cover under this
Coverage Part, our obligations are limited as
follows:
a. Primary Insurance
This insurance is primary except when b.
below applies. If other insurance is also
primary, we will share with all that other
insurance by the method described in c.
below.
b. Excess Insurance
This insurance is excess over any of the
other insurance, whether primary, excess,
contingent or on any other basis:
(1) Your Work
That is Fire, Extended Coverage,
Builder's Risk, Installation Risk or
similar coverage for "your work";
(2) Premises Rented To You
That is fire, lightning or explosion
insurance for premises rented to you
or temporarily occupied by you with
permission of the owner;
(3) Tenant Liability
That is insurance purchased by you to
cover your liability as a tenant for
"property damage" to premises rented
to you or temporarily occupied by you
with permission of the owner;
(4) Aircraft, Auto Or Watercraft
If the loss arises out of the maintenance
or use of aircraft, "autos" or watercraft to
the extent not subject to Exclusion g.of
Section A.– Coverages.
(5) Property Damage To Borrowed
Equipment Or Use Of Elevators
If the loss arises out of "property
damage" to borrowed equipment or
the use of elevators to the extent not
subject to Exclusion k.of Section A.–
Coverages.
Policy #
57SBWBM8201
57SBWBM8201
BUSINESS LIABILITY COVERAGE FORM
Form SS 00 08 04 05 Page 17 of 24
(6) When You Are Added As An
Additional Insured To Other
Insurance
That is other insurance available to
you covering liability for damages
arising out of the premises or
operations, or products and completed
operations, for which you have been
added as an additional insured by that
insurance; or
(7) When You Add Others As An
Additional Insured To This
Insurance
That is other insurance available to an
additional insured.
However, the following provisions
apply to other insurance available to
any person or organization who is an
additional insured under this Coverage
Part:
(a) Primary Insurance When
Required By Contract
This insurance is primary if you
have agreed in a written contract,
written agreement or permit that
this insurance be primary. If other
insurance is also primary, we will
share with all that other insurance
by the method described in c.
below.
(b) Primary And Non-Contributory
To Other Insurance When
Required By Contract
If you have agreed in a written
contract, written agreement or
permit that this insurance is
primary and non-contributory with
the additional insured's own
insurance, this insurance is
primary and we will not seek
contribution from that other
insurance.
Paragraphs (a)and (b)do not apply to
other insurance to which the additional
insured has been added as an
additional insured.
When this insurance is excess, we will
have no duty under this Coverage Part to
defend the insured against any "suit" if any
other insurer has a duty to defend the
insured against that "suit". If no other
insurer defends, we will undertake to do
so, but we will be entitled to the insured's
rights against all those other insurers.
When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(1)The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2)The total of all deductible and self-
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the
Declarations of this Coverage Part.
c. Method Of Sharing
If all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of
insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Under this method, each
insurer’s share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
Others To Us
a. Transfer Of Rights Of Recovery
If the insured has rights to recover all or
part of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rights are
transferred to us. The insured must do
nothing after loss to impair them. At our
request, the insured will bring "suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
b. Waiver Of Rights Of Recovery (Waiver
Of Subrogation)
If the insured has waived any rights of
recovery against any person or
organization for all or part of any payment,
including Supplementary Payments, we
have made under this Coverage Part, we
also waive that right, provided the insured
waived their rights of recovery against
such person or organization in a contract,
agreement or permit that was executed
prior to the injury or damage.
Policy #
57SBWBM8201
57SBWBM8201
ABCDEFGHIJ
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
HIRED AUTO AND NON-OWNED AUTO
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
This coverage is subject to all provisions in the moved from the place where they are
BUSINESS LIABILITY COVERAGE FORM not accepted by the "insured" for movement into
expressly modified herein:or onto the covered "auto"; or
c.After the "pollutants" or any property in
which the "pollutants" are contained areA. Amended Coverage:
moved from the covered "auto" to the placeCoverage is extended to "bodily injury" and where they are finally delivered, disposed of"property damage" arising out of the use of a "hired or abandoned by the "insured".auto" and "non-owned auto".
a.Paragraph above does not apply to fuels,B. Paragraph B. EXCLUSIONS is amended as lubricants, fluids, exhaust gases or otherfollows:similar "pollutants" that are needed for or
1.Exclusion g. Aircraft, Auto or Watercraft does result from the normal electrical, hydraulic
not apply to a "hired auto" or a "non-owned or mechanical functioning of the covered
auto"."auto" or its parts, if:
2.Exclusion e. Employers Liability does not (1)The "pollutants" escape, seep, migrate,
apply to "bodily injury" to domestic "employees"or are discharged or released directly
not entitled to workers’ compensation benefits from an "auto" part designed by its
or to liability assumed by the "insured" under an manufacturer to hold, store, receive,or
"insured contract".dispose of such "pollutants"; and
3.f. PollutionExclusion is replaced by the (2) The "bodily injury" and "property
following:damage" does not arise out of the
operation of any equipment listed in"Bodily injury" or "property damage" arising out
paragraphs 15.b.and 15.c.of theof the actual, alleged or threatened discharge,
definition of "mobile equipment".dispersal, seepage, migration, release or
escape of "pollutants":Paragraphs b.and c.above do not apply to
"accidents" that occur away from premisesa.That are, or that are contained in any
owned by or rented to an "insured" with property that is:
respect to "pollutants" not in or upon a (1)Being transported or towed by, handled,covered "auto" if:or handled for movement into, onto or
(1)The "pollutants" or any property infrom, the covered "auto";
which the "pollutants" are contained are(2)Otherwise in the course of transit by or upset, overturned or damaged as aon behalf of the "insured"; or result of the maintenance or use of a
(3)Being stored, disposed of, treated or covered "auto"; and
processed in or upon the covered
"auto".
b.Before the "pollutants" or any property in
which the "pollutants" are contained are
Form SS 04 38 09 09 Page 1 of 3
© 2009, The Hartford
(Includes copyrighted material of ISO Properties, Inc., with its permission)
Policy #57SBWBM8201
(2)The discharge, dispersal, seepage,company) for an "auto" owned by him or her
migration, release or escape of the or a member of his or her household.
"pollutants" is caused directly by such d.Anyone liable for the conduct of an "insured"
upset, overturn or damage as a result of described above but only to the extent of that
the maintenance or use of a covered liability.
"auto".D.With respect to the operation of a "hired auto"and
4.With respect to this coverage, the following "non-owned auto", the following additional
additional exclusions apply:conditions apply:
a. Fellow employee 1. OTHER INSURANCE
Coverage does not apply to "bodily injury"to a.Except for any liability assumed under an
any fellow "employee" of the "insured""insured contract" the insurance provided by
arising out of the operation of an "auto"this Coverage Form is excess over any
owned by the "insured" in the course of the other collectible insurance.
fellow "employee’s" employment.However, if your business is the selling,
b. Care, custody or control servicing, repairing, parking or storage of
Coverage does not apply to "property "autos", the insurance provided by this
damage" involving property owned or endorsement is primary when covered
transported by the "insured" or in the "bodily injury" or "property damage" arises
"insured’s" care, custody or control.out of the operation of a customer’s "auto"
by you or your "employee".C.With respect to "hired auto" and "non-owned auto"
coverage, Paragraph C. WHO IS AN INSURED is b.When this Coverage Form and any other
deleted and replaced by the following:Coverage Form or policy covers on the
same basis, either excess or primary, weThe following are "insureds":
will pay only our share. Our share is thea.You.proportion that the Limit of Insurance of our
b.Your "employee" while using with your Coverage Form bears to the total of the
permission:limits of all the Coverage Forms and policies
covering on the same basis.(1)An "auto" you hire or borrow; or
2. TWO OR MORE COVERAGE FORMS OR(2)An "auto" you don’t own, hire or borrow in
POLICIES ISSUED BY USyour business or personal affairs; or
If the Coverage Form and any other Coverage(3)An "auto" hired or rented by your
Form or policy issued to you by us or any"employee" on your behalf and at your
company affiliated with us apply to the samedirection.
"accident", the aggregate maximum Limit ofc.Anyone else while using a "hired auto" or "non-Insurance under all the Coverage Forms orowned auto" with your permission except:policies shall not exceed the highest applicable
(1)The owner or anyone else from whom you Limit of Insurance under any one Coverage
hire or borrow an "auto".Form or policy. This condition does not apply to
any Coverage Form or policy issued by us or an(2)Someone using an auto while he or she is
affiliated company specifically to apply asworking in a business of selling, servicing,
excess insurance over this Coverage Form.repairing, parking or storing "autos" unless
that business is yours.E.The following definitions are added:
(3)Anyone other than your "employees",G. LIABILITY AND MEDICAL EXPENSES
partners (if you are a partnership), members DEFINITIONS:
(if you are a limited liability company), or a 1."Hired auto" means any "auto" you lease,lessee or borrower or any of their hire, rent or borrow. This does not include"employees", while moving property to or any auto you lease, hire, rent or borrowfrom an "auto".from any of your "employees", your partners
(4)A partner (if you are a partnership), or a (if you are a partnership), members (if you
member (if you are a limited liability are a limited liability company),
Page 2 of 3 Form SS 04 38 09 09
Policy #57SBWBM8201
or your "executive officers" or members of
their households.
This does not include a long-term leased
"auto" that you insure as an owned "auto"
under any other auto liability insurance
policy or a temporary substitute for an
"auto" you own that is out of service
because of its breakdown, repair, servicing
or destruction.
2."Non-owned auto " means any "auto" you
do not own, lease, hire, rent or borrow
which is used in connection with your
business. This includes:
a."Autos" owned by your "employees" your
partners (if you are a partnership),
members (if you are a limited liability
company), or your "executive officers",
or members of their households, but
only while used in your business or your
personal affairs.
b.Customer’s "auto" that is in your care,
custody or control for service.
Form SS 04 38 09 09 Page 3 of 3
Policy #57SBWBM8201
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)
Process Date:
Page 1 of 6
Policy Expiration Date:
© 2000, The Hartford
WORKERS’ COMPENSATION BROAD FORM ENDORSEMENT
EXTENDED OPTIONS
Endorsement Number:Policy Number:
Effective Date: Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address:
Section I of this endorsement expands coverage provided under WC 00 00 00.
Section II of this endorsement provides additional coverage usually only provided by endorsement.
Section III of this endorsement is a Schedule of Covered States.
You may use the index to locate these coverage features quickly:
INDEX
SUBJECT PAGE SUBJECT PAGE
SECTION I
PARTS ONE and TWO
01 We Will Also Pay
PART - THREE
02 How This Insurance Works
PART - SIX
03 Transfer of Your Rights and Duties
04 Liberalization
SECTION II
VOLUNTARY COMPENSATION
INSURANCE
05 Voluntary Compensation Insurance
A. How This Insurance Applies
B. We Will Pay
C. Exclusions
D. Before We Pay
E. Recovery From Others
F. Employers’ Liability Insurance
EMPLOYERS’ LIABILITY STOP GAP
ENDORSEMENT
06 Employers’ Liability Stop Gap
Coverage
A. Stop Gap Coverage Limited to
Montana, North Dakota, Ohio,
Washington, West Virginia and
Wyoming
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
B. Part One Does Not Apply
C. Application of Coverage
D. Additional Exclusions
E. West Virginia
EXTENDED OPTIONS
01 Employers’ Liability Insurance
02 Unintentional Failure to Disclose
Hazards
03 Waiver of Our Right to Recover from
Others
04 Foreign Voluntary Compensation
A. How This Reimbursement Applies
B. We Will Reimburse
C. Exclusions
D. Before We Pay
E. Recovery From Others
F. Reimbursement For Actual Loss
Sustained
G. Repatriation
H. Endemic Disease
05 Longshore and Harbor Workers’
Compensation Act Coverage
Endorsement
SECTION III
01 Schedule of Covered States
3
3
3
3
4
4
4
4
4
4
4
4
5
5
5
5
5
5
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6
57WEGZR1786
06/16/2021
Natron Resources,Inc.
1480 Moraga Rd,Ste C 229
Moraga,CA 94556
06/16/202211/23/2021
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 2 of 6
SECTION I
PARTS ONE and TWO
1.WE WILL ALSO PAY
D.We Will Also Pay of Part One (WORKERS’
COMPENSATION INSURANCE); and
E.We Will Also Pay of Part Two
(EMPLOYERS’LIABILITY INSURANCE)is
replaced by the following:
We Will Also Pay
We will also pay these costs,in addition to
other amounts payable under this insurance,
as part of any claim,proceeding,or suit we
defend:
1.reasonable expenses incurred at our
request,INCLUDING loss of earnings;
2.premiums for bonds to release
attachments and for appeal bonds in
bond amounts up to the limit of our
liability under this insurance;
3.litigation costs taxed against you;
4.interest on a judgment as required by law
until we offer the amount due under this
law; and
5.expenses we incur.
PART THREE
2.How This Insurance Applies
Paragraph 4.of A.How This Insurance Applies of
Part 3 (Other States Insurance)is replaced by the
following:
4.If you have work on the effective date of this
policy in any state not listed in Item 3.A.of the
Information Page,coverage will not be afforded
for that state unless we are notified within sixty
days.
PART SIX
3.Transfer Of Your Rights and Duties
C.Transfer Of Your Rights and Duties of Part 6
(Conditions) is replaced by the following:
Your rights or duties under this policy may not be
transferred without our written consent.
If you die and we receive notice within sixty days
after your death,we will cover your legal
representative as insured.
4.Liberalization
If we adopt a change in this form that would 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 II
VOLUNTARY COMPENSATION ANDEMPLOYERS’
LIABILITY COVERAGE
5.Voluntary Compensation Insurance
A.How This Insurance Applies
This insurance applies to bodily injury by
accident or bodily injury by disease.Bodily
injury includes resulting death.
1.The bodily injury must be sustained by
any officer or employee not subject to the
workers’compensation law of any state
shown in Item 3.A.of the Information
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.
3.The bodily injury must occur in the United
States of America,its territories or
possessions,or Canada,and may occur
elsewhere if the employee is a United States
or Canadian citizen,or otherwise legal
resident,and legally employed,in the United
States or Canada and temporarily away from
those places.
4.Bodily injury by accident must occur during
the policy period.
5.Bodily injury by disease must be caused or
aggravated by the conditions of the
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 3 of 6
officer’s or employee’s employment.The
officer’s or employee’s last day of last
exposure to the conditions causing or
aggravating such bodily injury by disease
must occur during the policy period.
B.We Will Pay
We will pay an amount equal to the benefits
that would be required of you as if you and
your employees were subject to the workers’
compensation law of any state shown in Item
3.A.of the Information Page.We will pay
those amounts to the persons who would be
entitled to them under the law.
C.Exclusion
This insurance does not cover:
1.any obligation imposed by workers’
compensation or occupational disease
law or any similar law.
2.bodily injury intentionally caused or
aggravated by you.
3.officers or employees who have elected
not to be subject to the state workers’
compensation law.
4.partners or sole proprietors not covered
under the Standard Sole Proprietors,
Partners,Officers and Others Coverage
Endorsement.
D.Before We Pay
Before we pay benefits to the persons
entitled to them, they must:
1.Release you and us,in writing,of all
responsibility for the injury or death.
2.Transfer to us their right to recover from
others who may be responsible for the
injury or death.
3.Cooperate with us and do everything
necessary to enable us to enforce the
right to recover from others.
If the persons entitled to the benefits of this
insurance fail to do those things,our duty to
pay ends at once.If they claim damages
from you or from us for the injury or death,
our duty to pay ends at once.
E.Recovery From Others
If we make a recovery from others,we will
keep an amount equal to our expenses of
recovery and the benefits we paid.We will
pay the balance to the persons entitled to it.
If the persons entitled to the benefits of this
insurance make a recovery from others,they
must reimburse us for the benefits we paid them.
F.Employers’ Liability Insurance
Part Two (Employers’Liability Insurance)applies
to bodily injury covered by this endorsement as
though the State of Employment was shown in
Item 3.A. of the Information Page.
This provision 5.does not apply in New Jersey or
Wisconsin.
EMPLOYERS’ LIABILITY STOP GAP COVERAGE
6.Employers’ Liability Stop Gap Coverage
A.This coverage only applies in Montana,North
Dakota,Ohio,Washington,West Virginia and
Wyoming.
B.Part One (Workers’Compensation Insurance)
does not apply to work in states shown in
Paragraph A above.
C.Part Two (Employers’Liability Insurance)applies
in the states,shown in Paragraph A.,as though
they were shown in Item 3.A.of the Information
Page.
D.Part Two,Section C.Exclusions is changed by
adding these exclusions.
This insurance does not cover;
5.bodily injury intentionally caused or
aggravated by you or in Ohio bodily injury
resulting from an act which is determined by
an Ohio court of law to have been committed
by you with the belief than an injury is
substantially certain to occur.However,the
cost of defending such claims or suits in Ohio
is covered.
13.bodily injury sustained by any member of the
flying crew of any aircraft.
14.any claim for bodily injury with respect to
which you are deprived of any defense or
defenses or are otherwise subject to penalty
because of default in premium under the
provisions of the workers’compensation law
or laws of a state shown in Paragraph A.
E.This insurance applies to damages for which you
are liable under West Virginia Code Annot.S 23-
4-2.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 4 of 6
EXTENDED OPTIONS
1.Employers’ Liability Insurance
Item 3.B.of the Information Page is replaced by
the following:
B.Employers’ Liability Insurance:
1.Part Two of the policy applies to work in
each state listed in Item 3.A.
The Limits of Liability under Part Two are
the higher of:
Bodily Injury
by Accident $500,000 Each Accident
Bodily Injury
by Disease $500,000 Policy Limit
Bodily Injury
by Disease $500,000 Each Employee
OR
2.The amount shown in the Information
Page.
This provision 1 of EXTENDED OPTIONS does
not apply in New York because the Limits Of Our
Liability are unlimited.
In this provision the limits are changed from
$500,000 to $1,000,000 in California.
2.Unintentional Failure to Disclose Hazards
If you unintentionally should fail to disclose all
existing hazards at the inception date of your
policy,we shall not deny coverage under this
policy because of such failure.
3.Waiver of Our Right To Recover From Others
A.We have the right to recover our payments
from anyone liable for an injury covered by
this policy.We will not enforce our right
against any person or organization for whom
you perform work under a written contract
that requires you to obtain this agreement
from us.
This agreement shall not operate directly or
indirectly to benefit anyone not named in the
agreement.
B.This provision 3.does not apply in the states
of Pennsylvania and Utah.
4.Foreign Voluntary Compensation and Employers’
Liability Reimbursement
A.How This Reimbursement Applies
This reimbursement provision applies to bodily
injury by accident or bodily injury by disease.
Bodily injury includes resulting death.
1.The bodily injury must be sustained by an
officer or employee.
2.The bodily injury must occur in the course of
employment necessary or incidental to work
in a country not listed in Exclusion C.1.of this
provision.
3.Bodily injury by accident must occur during
the policy period.
4.Bodily injury by disease must be caused or
aggravated by the conditions of your
employment.The officer or employee’s last
exposure to those conditions of your
employment must occur during the policy
period.
B.We Will Reimburse
We will reimburse you for all amounts paid by
you whether such amounts are:
1.voluntary payments for the benefits that
would be required of you if you and your
officers or employees were subject to any
workers’compensation law of the state of
hire of the individual employee.
2.sums to which Part Two (Employers’Liability
Insurance)would apply if the Country of
Employment were shown in Item 3.A.of the
Information Page.
C.Exclusions
This insurance does not cover:
1.any occurrences in the United States,
Canada,and any country or jurisdiction
which is the subject of trade or economic
sanctions imposed by the laws or regulations
of the United States of America in effect as of
the inception date of this policy.
2.any obligation imposed by a workers’
compensation or occupational disease law,
or similar law.
3.bodily injury intentionally caused or
aggravated by you.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 5 of 6
4.liability for any consequence,whether
direct or indirect,of war,invasion,act of
Foreign enemy,hostilities (whether war
be declared or not),civil war,rebellion,
revolution,insurrection or military or
usurped power.No endorsement now or
subsequently attached to this policy shall
be construed as overriding or waiving
this limitation unless specific reference is
made thereto.
D.Before We Pay
Before we reimburse you for the benefits to
the persons entitled to them,you must have
them:
1.release you and us,in writing,of all
responsibility for the injury or death,
2.transfer to us their right to recover from
others who may be responsible for their
injury or death,
3.cooperate with us and do everything
necessary to enable us to enforce the
right to recover from others.
If the persons entitled to the benefits paid fail
to do these things,our duty to reimburse
ends at once.If they claim damages from us
for the injury or death,our duty to reimburse
ends at once.
E.Recovery From Others
If we make a recovery from others,we will
keep an amount equal to our expenses of
recovery and the benefits we reimbursed.
We will pay the balance to the persons
entitled to it.If persons entitled to the
benefits make a recovery from others,they
must repay us for the amounts that we have
reimbursed you.
F.Reimbursement for Actual Loss
Sustained
This endorsement provides only for
reimbursement for the loss you actually
sustain.In order for you to recover loss or
expenses under this reimbursement you
must:
1.actually sustain and pay the loss or
expense in money after trial, or
2.secure our consent for the payment of
the loss or expense.
G.Repatriation
Our reimbursement includes the additional
expenses of repatriation to the United States
of America necessarily incurred as a direct result
of bodily injury.
Our reimbursement shall be limited as follows:
1.to the amount by which such expenses
exceed the normal cost of returning the
officer or employee if in good health, or
2.in the event of death,to the amount by which
such expenses exceed the normal cost of
returning the officer or employee if alive and
in good health.
In no event shall our reimbursement exceed the
bodily injury by accident limit shown in Item 3.B.
of the Information Page as respects any one
such officer or employee whether dead or alive.
H.Endemic Disease
The word “disease”includes any endemic
diseases.
The coverage applies as if endemic diseases
were included in the provisions of the workers’
compensation law.
5.Longshore and Harbor Workers’Compensation
Act Coverage
General Section C.Workers’Compensation Law
is replaced by the following:
C.Workers’ Compensation Law
Workers’Compensation Law means the workers
or workers’compensation law and occupational
disease law of each state or territory named in
Item 3.A.of the Information Page and the
Longshore and Harbor Workers’Compensation
Act (33 USC Sections 901-950).It includes any
amendments to those laws that are in effect
during the policy period.It does not include any
other federal workers or workers’compensation
law,other federal occupational disease law or the
provisions of any law that provide
nonoccupational disability benefits.
Part Two (Employers’Liability Insurance),C.
Exclusions,exclusion 8,does not apply to work
subject to the Longshore and Harbor Workers’
Compensation Act.
This coverage does not apply to work subject to
the Defense Base Act,the Outer Continental
Shelf Lands Act,or the Nonappropriated Fund
Instrumentalities Act.
Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 6 of 6
SECTION III
1.SCHEDULE OF COVERED STATES
A.This endorsement only applies in the states
listed in this Schedule of Covered States.
B.If a state,shown in Item 3.A.of the Information
Page,approves this endorsement after the
effective date of this policy,this endorsement 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
Countersigned by
Authorized Representative
Natron Amendment 2 for Sports Center Fire
Alarm System Replacement
Final Audit Report 2022-11-09
Created:2022-11-09
By:City of Cupertino (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAANk8KroaGkiR22mmb3NeVzU2OQKo9GszV
"Natron Amendment 2 for Sports Center Fire Alarm System Repl
acement" History
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