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HomeMy Public PortalAboutC-20-031 - Mediastar, Inc. Amendment No. 2, On-Site and Remote Audio Visual Equipment SupportAMENDMENT NO.2 TO AGREEMENT FOR CONTRACT SERVICES THIS AMENDMENT TO THE AGREEMENT FOR CONTRACT SERVICES ("Amendment No. 2") by and between the CITY OF CARSON, a California municipal corporation ("City"), and MEDIASTAR INC., a California corporation ("Consultant"), is entered into effective as of the 11p day of June, 2020. RECITALS A. City and Consultant entered into that certain Agreement for Contract Services dated March 17, 2020 ("Agreement") whereby Consultant agreed to provide City services to maintain and operate certain audio/visual equipment and software used for City Council meetings, including those concerning remote interfacing capabilities that became necessary due to the COVID-19 pandemic and State issued guidelines, until expiration of the Agreement on June 30, 2020. B. On May 5, 2020, City and Consultant amended the Agreement ("Amendment No. 1") to add services for remote management of City Council Special Meetings increasing compensation by $11,250 from $62,972 for a total Contract Sum not to exceed $74,222. C. City and Consultant now desire to amend the Agreement again to extend the term an additional six (6) months from July 1, 2020 through December 31, 2020 ("Extended Term"), to add additional support for on-site and remote regular City Council meetings and provide on-site training to City staff on how to manage the meetings, to remotely manage all meetings other than regular City Council meetings and train City staff for the same, and to train City staff how to modify the existing schedule for airing on the local cable channels, City website and City's social media (collectively, "Additional Services"). D. The Contract Sum of $74,222 will be increased by $24,900 attributable to the Additional Services provided during the Extended Term for a new total Contract Sum of $99,122. TERMS 1. Contract Changes. The Agreement is amended as provided herein (new text in hold italics and deleted text in strike eugh). a. Section 2.1, "Contract Sum," of the Agreement is hereby amended to read as follows: "Subject to any limitations set forth in this Agreement, City agrees to pay Consultant the amounts specified in the "Schedule of Compensation" attached hereto as Exhibit "C" and incorporated herein by this reference. The total compensation, including reimbursement for actual expenses, shall not exceed Ninety Nine Thousand One Hundred Twenty Two Dollars Seven-ty Foul TL,o,,s.,,-..a Two Hidn&ed TweiA , Two 01007.0001/651334.1 - 1 - Dollars ($99,122$74,2Q) ("Contract Sum"), unless additional compensation is approved pursuant to Section 1.8." b. Section 3.4, "Term," of the Agreement is hereby amended to read as follows: "Unless earlier terminated in accordance with Article 7 of this Agreement, this Agreement shall continue in full force and effect until hine 30, 20 December 31, 2020, except as otherwise provided in the Schedule of Performance (Exhibit "D")." C. Section 9.9, "City Responsibilities," of the Agreement is hereby amended to read as follows: "9.9 City Responsibilities. a) City will cooperate with Consultant to perform the Services, including without limitation with respect to preparing the site for the performance of the Services and supplying all necessary information, which shall be accurate, complete and timely. City shall ensure that it has the right to provide all such information and data to Consultant for purposes of performance of the Services, within the context of the protection of privacy rights and as limited by California law. b) City will respond promptly to any request from Consultant to provide direction, information, approvals, authorizations or decisions that are necessary for Consultant to perform Services or deliver the Products. c) The City will ensure that the on-site training sessions provided to City staff during City Council regular meetings are compliant with CDC guidelines and that the City staff/interns are tested for Covid-19 prior to the training sessions in accordance with CDC guidelines or City's standard Covid-19 precautionary procedures associated with gatherings within City facilities." d. Section VII of Exhibit "A," "Scope of Services," of the Agreement, is hereby deleted in its entirety and replaced with the following: "VII. Additional Services. 1. Support for Regular Citv Council Meetings. Consultant shall provide support for on-site and remote regular City Council meetings. This includes two (2) site visits per month such that the site visits will coincide with regular Council meetings. At least one (1) of Consultant's staff members will be deployed for each Council meeting. The proposed cost associated with these services are for support services only and do not include any replacement of equipment or any project labor -2- 01007.0001/651334.1 beyond providing support resources for the site. Consultant will deliver training to City staff on-site during these meetings. Consultant shall also train City staff on how to modify the existing schedule for airing on the local cable channels, City website and City's social media, and add the meeting to the existing schedule as directed by the Contract Officer (limited to videos and a few slides). Consultant will send the finished video to the video server. 2. Remote Management of Meetings Other than Regular City Council Meetings for the Period July 2020 through September 2020. For all meetings starting July 2020 through September 2020 (for a total of six meetings) other than regular Council meetings (e.g., special meetings, Planning Commission meetings, etc.), Consultant shall remotely manage those meetings and also train City staff on how to manage the meetings. During these remote meetings, Consultant shall conduct a pre -meeting test of recording, and audio and external source equipment (currently a Zoom capable PC in the new studio). Consultant will notify City staff if any equipment is not working as required prior to the meeting. During the meeting, Consultant's staff will manage the video switching, muting and audio levels. Consultant will also create lower 113 graphics to be overlaid on the meeting video and slides for the beginning of the meeting, end of the meeting and closed session, if needed. After the meeting, Consultant will post -edit the meeting, trimming, fixing audio and video issues with the recording and re -encoding the meeting. Consultant will send the finished video to the video server. Consultant shall also install additional cabling to allow remote management of the cameras until the Phase II cameras are installed at a later date. Consultant will install such cables by no later than September 1, 2020." e. Section VII of Exhibit "A," "Scope of Services," of the Agreement, is hereby renumbered to Section VIII. f. Sections VIII of Exhibit "A," "Scope of Services," of the Agreement, is hereby renumbered to Section IX. g. Section VII of Exhibit "C," "Schedule of Compensation," of the Agreement, is hereby amended to read as follows: "The City shall compensate Consultant an amount of $20,400 for performance of services under Task VII(I) of Exhibit "A" and an amount of $4,500 for Performance of services under Task VII(2) of Exhibit "A," for a total not to exceed amount of $24,900 under Task VII of Exhibit `A. "' -3- 010070001 /651334.1 h. Section VII of Exhibit "C," "Schedule of Compensation," of the Agreement, is hereby reunumbered to Section VIII and amended to read in its entirety as follows: "The total compensation for the Services (inclusive of Section I, Section II, Section III, Section IV, and Section V, and Section VII of Exhibit "A," Scope of Services) shall not exceed $99,1222, as provided in Section 2.1 of this Agreement." i. Section VIII of Exhibit "C," "Schedule of Compensation," of the Agreement, is hereby reunumbered to Section IX. j. Section I(F) of Exhibit "D," "Schedule of Performance," of the Agreement, is hereby added as follows: "F. All tasks listed under Section VII(1) of Exhibit "A" will be performed between July 1, 2020 and December 31, 2020 (the Extended Term), and all tasks performed under Section VII(2) of Exhibit "A" shall be performed between July 2020 and September 2020. " 2. Continuing Effect of Agreement. Except as amended by this Amendment No. 2, all provisions of the Agreement and Amendment No. 1 shall remain unchanged and in full force and effect. From and after the date of this Amendment No. 2, whenever the term "Agreement" appears in the Agreement, it shall mean the Agreement, as amended by this Amendment No. 2 and Amendment No. 1. 3. Affirmation of Agreement; Warranty Re Absence of Defaults. City and Consultant each ratify and reaffirm each and every one of the respective rights and obligations arising under the Agreement and Amendment No. 1. Each parry represents and warrants to the other that there have been no written or oral modifications to the Agreement other than as provided herein and Amendment No. 1. Each parry represents and warrants to the other that the Agreement, as amended by Amendment No. 1 and this Amendment No. 2, is currently an effective, valid, and binding obligation. Consultant represents and warrants to City that, as of the date of this Amendment No. 2, City is not in default of any material term of the Agreement and that there have been no events that, with the passing of time or the giving of notice, or both, would constitute a material default under the Agreement. City represents and warrants to Consultant that, as of the date of this Amendment No. 2, Consultant is not in default of any material term of the Agreement and that there have been no events that, with the passing of time or the giving of notice, or both, would constitute a material default under the Agreement. -4- 01007.0001/651334.1 4. Adequate Consideration. The parties hereto irrevocably stipulate and agree that they have each received adequate and independent consideration for the performance of the obligations they have undertaken pursuant to this Amendment No. 2. 5. Authority. The persons executing this Amendment No. 2 on behalf of the parties hereto warrant that (i) such parry is duly organized and existing, (ii) they are duly authorized to execute and deliver this Amendment No. 2 on behalf of said parry, (iii) by so executing this Amendment No. 2, such parry is formally bound to the provisions of this Amendment No. 2, and (iv) the entering into this Amendment No. 2 does not violate any provision of any other agreement to which said party is bound. [SIGNATURES ON FOLLOWING PAGE] -5- 01007.0001/651334.1 IN WITNESS WHEPEOF, the parties hereto have executed this Amendment No. ?cin the date and year first -above written. o� Gp►R 'ON, CITY. r Cid CARSON,, Alb rt R tiles, Mayor ATTEST: City Clerk APPROVED R t F!r i ! e e ALESHIRE t 11 • ► 6;�74�' Sunny K. Soltani, City Attorney (IJl) CONSULTANT: MEDIASTAR INC., a California corporation corporation By; Naive: Title: By:. Ai��o Name: t..F-Ctw ' C-.(,otj Title: 5;6- -44-2z Address: -7vr- _ n�.�►�� ri+t c164 L,0 C.,k Two corporate officer signatures required when Consultant is a corporation, with one signature required from each of the following groups: I) Chairman of the Board, President or any Vice President; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. CONSULTANT'S SIGNATURES SHALL BE DULY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL, BE INCLUDED AS MAY BE REQUIRED BY THE BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO CONSULTANT'S BUSINESS ENTITY. -6- 01007 0001 63034 1 IN WITNESS WHEREOF, thep arties hereto have executed this Amendment No. 2 on the date and year first -above written. ATTEST: Donesia Gause-Aldana, City Clerk APPROVED AS TO FORM: ALESHIRE & WYNDER, LLP Sunny K. Soltani, City Attorney (rj 1) CITY: CITY OF CARSON, a municipal corporation Albert Robles, Mayor CONSULTANT: MEDIASTAR INC., a California corporation By: h4�_� Name: 7 II)ve— P R Title: (GP**- / By: AfWdLD Name: Lj,SUz- GCO�Jey Title: Seclt_c_r� �_ Address: 7v2- nna�F,�,�,�_ AL %"-2Z 1 G4t L- C -4-t a s� z-6 Two corporate officer signatures required when Consultant is a corporation, with one signature required from each of the following groups: 1) Chairman of the Board, President or any Vice President; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. CONSULTANT'S SIGNATURES SHALL BE DULY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE REQUIRED BY THE BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO CONSULTANT'S BUSINESS ENTITY. -6- 01007.0001/651334.1 ,g,c� CERTIFICATE OF LIABILITY INSURANCE 11rPr-"V DAT (MWOD(YYYYI THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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). PRODUCER Jeff Fowler Insurance Services, INC CONTACT NAME: Jeff Fowler 426 Broadway #205 Chico, CA 9592$ _ �NzEsONE (530)267.-6268 _ IOC Nm: 530j267-5555 AODREss: jeMfowledris.com, INSURERS AFFORDING COVERAGE NAICi License #: OL07979 INwRERA: HartfpLdlnsurance Company 57SBABM0907 INsuRt o MEDIASTAR INC 702 MANGROVE AVE STE 221 CHICO, CA 95926 TwRERa: MARKEL INSURAN_Ci:�QMP,AtV tNwnERc: INSURER D: INSURER E: INSURER F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUaJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_. LPAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM$. I Tp TYPE OF INSURANCE }A �� POLICY NUMBER MMtO YJYYW� POMtuobr'yYYv LIMITS A XCOMMERCIALGENERALLIAE(UTY - CLAWS -MADE I OCCUR ( Y Y 57SBABM0907 �07117JI119 117111J1120: EACHOCCURRENCE 3 1 000 000 PREW S�Eai omm t) S 300,000_ V ( LIED ExP (Any ore penes) S 5,000 r I 'i PERS' ONALaAOV INJURY S 2, 00,000 GEML AGGREGATE LIMIT APPLIES PER. ('Ro LOC POLICY I[JJE GENERAL AGGREGATE s 2.000,000 PRODUCTS-COMPA�PAGG 3W 2,000,000 OTHER: Is A I ALI OMOSILE UABIUTY ! 57SBASM0907 07112/2019 07112/2020 Ea E!ad101] IN LF UJAIT 1, 1�OU0�t)QO PX ANY AUTO OWNED I SCHEOULEDBODILY AUTOS ONLY AUTOS NOWONMED X AUTOS ONLY 8004LYINJURY[Perpendn) 3 INJURY Par arrident i i IHIRED PROPERTY AMAGEAUTOSONLY S UMBRELLA LIAR OCCUR EACH OCCURRENCE 13 3 UA E=ES}ED CLAIMS -MAI I t ( I ` r AGGREGATE S ( RETENTIONS S B WORMERS COMPENSATION YIN AND EMPLOYERS' LIABILITY AW PROPRIETORIPARTNERrEXBCUT,VE a OFFICFJ2'MEMBER EXCLUDED? [Mamdalary In NHl WA JJJ Y MWC0154455-01 1WI112019 I 18/15/2020 I (EL V E L. EACH ACCIDENT Is 1,000 000 J DISEASE -EA E.MKOYEEI3_ --- 1,000,000 It yyea dsmbe under DESCRIPi1DNOrOPERAT10NSbetow i IELD45EASE-POLICY r -- LIMIT S 1,000,000 I I DESCRIPTION OF OPERATIONS I LOCATION3+ VEHICLES (ACORD I07, AddM0nA1 Ramirks Schadul+, maty be atbched Irmo spate Is nqukndl 1. City of Carson, Its elected and appointed officers, employees, volunteers and agents are additional insureds on GL and Auto policies, 2. GL policy is Primary and Non-contributory . 3, Waiver of Subrogation endorsement in favor of City of Carson OR in favor of additional insured. CITY OF CARSON ' ">' 701 E Carson Street CARSON, CA 90745 6/12/2020 y.n«ves.ue r ,vn SHOULD ANY OF THE ABOVE DESCRt9ED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE 15 All rights reserved. ACORD 25 (20181(13} The ACORD name and Pogo are registered marks of ACORD Printed by JRF on October 22, 2019 at 03 43PM M-! THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAR IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 57 S13A SM0907 SC Named Insured and Mailing Address; MEDIASTAR INC 702 MANGROVE AVE STE 221 CH ICO CA 9S926 Policy Change Effective Date: 10/23/19 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 002 Agent Name: NETWORKED INSURAPICC AGENTS LLC Code: 121637 POLICY CHANGES: SENTINEL, INSURANCE COMPANY, LIMI`ED ANY CHANGES IN YOUR PREMIUM WILL 132 REFLECTED IN YOUR NEXT BILLIN=G STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL, ADDITIONAL PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE. $28.00 `INCLUDES ADDITIONAL TERRORISM PREMIUM OF: $1.00 LOCATION 001 BUILDING 001 IS REVISED PRO RATA FACTOR: 0.721 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. form SS 1211 0405 T Page Oat (CONTINUED ON NEXT PAGE) Process Date: 10/23,119 Policy Effective Date: 01112/19 Policy Expiration Date: 07/12/20 POLICY CHANGE (Continued) Policy Number: 57 SBA BM0907 Policy Change Number: 002 BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED WAIVER OF SUBROGATION IS ADDED: FOR14 SS 12 15 LOCATION 001 BUILDING 001 CITY OF CARSON 701 E CARSON ST CARSON, CA 90745 FORM N-JMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDIT1ONAL INSURED - PERSON -ORGANIZATION FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: SS 12 15 03 00 Form SS 12 11 04 05 T Page 002 Process Date: 10/23/19 Policy Effective Date: 07/12/19 Policy Expiration Date: 07/12/20 POLICY NUMBER: 57 SSA BM0907 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION THE CITY OF TRACY (INCLLDING ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS) 333 CIVIC CENTER PLAZA TRACY, CA 95376 CITY OF CARSON 701 E CARSON ST CARSON, CA 90745 Form IH 12 00 11 85 T SEQ. NO, 001 Printed in U.S.A. Page 001 Process Date: 10/231/19 Expiration Date: 07/12/20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM We waive any right of recovery we may have against: 1. Any person or organization shown in the Declarations, or 2. Any person or organization with whom you have a contract that requires such waiver, Form SS 1215 03 00 0 2000, The Hartford Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY INFORMATION PAGE ENDORSEMENT The following item(s) Insured's Name (WC 89 06 01) Policy Number (WC 89 06 02) Effective Date (WC 89 06 03) Expiration Date (WC 89 06 04) Insured's Mailing Address (WC 8906 05) Experience Modification (WC 89 04 06) Producer's Name (WC 89 06 07) Change in Workplace of Insured (WC 89 06 08) Insured's Legal Status (WC 89 06 10) Item 3.A. States (WC 89 06 1 1) is changed as follows: Adion lypc IITQlIous Valuc Item 3.B. Limits (WC 89 06 12) Item 3.C. States (WC 89 06 13) .X Item 3.D. Endorsement Numbers (WC 89 06 14) Item 4. Class, hate, Other (WC 89 04 15) Interim Adjustment of Premium (WC 89 04 16) WC 89 06 00 B (Ed 7-01) Carrier Servicing Office (WC 89 06 17) 1nterstatellntraslate Risk ID Number (WC 89 06 18) Carrier Number (WC 89 06 19) Issuing Agency/Producer Office Address (WC 89 06 25) Ncw Value Arid %Vaiterof N'A 'Type Individual S(tbmgauon State CA Class Code 8851) Payroll 11 Suhrugant Name CITY OF CARSON Subrogant Address 701 E Carson Street Suhrugant Cry CARSON Stato CA Posta! Code 90735 1.5ccttlre Date 10P -M019 Expuation Date 0SA3MMO Total Estimated Annual Premium $625.00 Premium Adjustment $362.00 Minimum Premium S 23.00 Deposit Premium $643.00 All other terms and conditions of this policy remain unchanged. This endorsement changes the pol cy to which it is attached and is effective on the date Issued unless otherwise stated (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/2212019 Policy No MtWC0154455-01 Insured: medlastar inc Insurance Company Markel Insurance Company Countersigned by WC890600B Ed. 7-01 O 2601 Nahcna! Cvjacl on Inc Endorsement No Premi,im (See Attached) 1111NI I Ifflil10111Bin 11111 t °t� �8�►��II�III����I ��l�l�l� llll� W4719 0134d6 -a6«.-03 43.1023" 019 M4NCQS54d34i 1 MARKET, INSURANCE COMPANY A STOCK COMPANY TEN PARKWAY NORTH �����p DEERFIELD, IL 50015 800-431-1270 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE NCC I No. 22616 New No. State Unemployment I.D. No. or Identifying Number as Required: I. Insured: Mailing mediastar inc dba 702 Mangrove Ave Ste 221 Address Chico, CA 95926-3948 Email Address: davep2006/mediastar-sg.eom El Individual ElPartnership Policy No. MWC0154435-01 Renewal of Policy Number New FEIN: 205783590 Producer: Jeff Fowler Insurance Services Mailing 426 Broadway St Ste 205 Address Chico, CA 95928 "1Corporation or Other workplace not shown above: See Attached location Schedule 2. Policy Period: The policy is from 08113/2019 to 0 85 1 512 0 20 [12.01 AM Standard Time] at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of this policy applies to the Workers Compensation Law of the states listed here: CALIFORNIA B. Employers liability Insurance: Part Two of this policy applies to work in each state listed in Item 3A . The limits of our liability under Part Two are: Bodily Injun. by Accident: S 1,0510,000 each accident Bodily Injunv by Discasc: S 1,000,000 policy limit Bodily Injury by Discasc: S i,000,ow cath employ cc C. Ocher States Insurance: Part Three of this policy applies to the states, if any, listed here: All states except those listed in Item 3A of the Information Page and the following states or territories: District of Columbia, ID, MT, NY, ND, OH, OR, WA, WY, Puerto Rico and US Virgin Islands. D. This Policy includes these endorsements and schedules: MDWCt000A, MJWC1000, MPIL 1007, MPIL 1083, NIPWC10000510, MWC 1202 -CA, MWC12000510, MWC14030510,MWC14040510, PN049901G, PN049902B, PN049904, WC000000C, WC000419, WC000472B, WC040002, WC040003, WC040004, WC040005, WC040301D, WC040303C, WC040306, WC040360B, WC040601A, WC8906008 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Classification No Estimated Annual $100 of Estimated Annual Premium Remuneration Remuneration See WC 04 00 05 Extension of Information Page MINIMUM PREMIUM $23.00 TOTAL ESTIMATED ANNUAL PREMIUM $625.00 TAXES & ASSESSMENTS $18.00 IF INDICATED BELOW, INTERIM ADJUSTMENTS OF PREMIUM SHALL BE MADE: X Annually Semi -Annually Quarterly Monthly $643,00 Deposit Premium $Per Installment Endr Issuing Office: Omaha, Nebraska Countersigned by: MDWC 1000A (05!15) 2of9 r WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 44 00 02 (Ed. 7-98) EXTENSION OF INFORAIAT1ON PAGE Schedule of Name Insured ITEM 1 Policy No. IvIWC015 #455-01 Name Insured FEIN mediastar inc 205785590 C 1995 by the Workers' Compensation insumnca Ratng Bureau of California All rights reserved. From the =tRB'c California Workers Compensation Insurance Forms Manual 0 2001. 3 o f 9 tv01MIRS C'U'11ITNSATION AM) E'AI 'LOVCIIS LL%13tL1T1' I\St)R 1\["F: POLICY EXTENSION OF INFORMATION PAGE Schedule of Locations ITEM 1 Svc W 00 03 (1�d. 7.9S) Policy No. MWC0154455-01 Location FEIN PHONE CODE ENTITY TYPE 1 702 Mangrove Ave Ste 221 205785590 530-898-9588 7371 Corporation Chico, CA 95926-3943 ©1996 by the Workers' Compensation Insurance Rating Bureau of California. Aa rights reserved. From the WO RS's California Workers' Compensation Insurance Forms Manual 0 2WI 4 0 f g u orartra�s c�oa�rritis:�•rroti ,+,�v r:�rrf.o� r�.las r,r.><na.r r� 1�:;l�rz.'<:�cr�, rc�r<rc� EXTENSION OF INFORMATION PAGE Schedule of Farms ITEM 3D Policy No, NBVC0154455-01 MDWCIo00A, I lJWC1000. MPll. 1007, MP1L 1093, N1PWC10000510, MNVC 1202 -CA, MWC12000510, MN1"C14030510, NIWC14040510, PN049901G, PN049902B, PN0 49904, WC000000C, WC000419, WC00042213, CALIFORNIA WC040002, WC040003, WC040004, WC040005, WC040301 D, WC040303C, WC040306. WC04036043, WC040001 A, WC890600B b 1998 by the'Ncrkers' Comparrualion knsuranca Rating Bureau of Caticrrria All rights reserved From the WCIRB's Calitarnia Walkers Compensation Insuranea farms Mantra' O 2001. 5 of 9 tier 04 W 04 (Ed. 7 98) WORKERS COMPEN-SA CION AN'D EMPLOYERS I.lMMAT! INSt RUSCE POLI n - EXTENSION OF INFORMATION PAGE Classifications ITEM 4 Premium Basis Total Estimated Annual Code Classification Remuneration 8359 Computer Programming Or $0.00 Software Development Total Amount Due SGC 0400 05 (Ed. 7 M Policy No. NINVC0154455-01 Rate Per Estimated 5100 of Annual Remuneration Premium 0.130 $0.00 sa.00 lfyou elect a payment plan, then you will be subject to installment fees for each payment ranging Pram $3-S10 depending on the state. If you elect electronic funds transfer, these fees will not apply. 1996 by the Workers° Compensation Insurance Rating Bureau of California. All rights reserved_ From tho VOCIRH's California Workors' Compensation Insuranoo Forms Manual 2801 6 01`9 NVORIi2:RS COMPENSATION AND ENIPLOVERS l.I,tBi111n,1N'St IZAN E 1101.Irl" EXTENSION OF INFORII�IATION PAGE Classifications ITEM 4 Code Classification 8859 Computer Programming Or 5100 of Software Development 0930 Waiver Premium Subject Premium 0.130 Total Subject Premium Modified Premium 98R9 Schedule Rating Standard Premium 0900 Expense Constant 5250,00 Estimated Annual Premiurn WC Admin Revolving Assessment $125.00 Fraud Surcharge UEBTFA Subsequent Injury Fund 5250.00 Occupation Safety and Health Fund Surcharge Labor Enforcement and $9.00 Compliance Fund Surcharge 0,288 Total Amount Due it G oa Oil l05 (Vk 7-98) Policy No. MWC0154455-01 Premium Basis Total Rate Per Estimated Estimated Annual 5100 of Annual Remuneration Remuneration Premium $0.00 0.130 50.00 5.000 $250.00 $250,00 5250,00 $250.00 0,500 $125.00 $375,00 5250.00 SG25.00 1.448 $9.00 0,288 $2.00 0.083 $1.00 0,2 74 $2.00 0.377 $2,00 0.343 $2.00 Sb43.00 Ifyou elect a payment plan, then you will be subject to installment fees for each payment ranging from S3-$10 depending on the state. If you elect electronic Funds transfer, these fees will not apply, C, 1998 by the Workers' Ccmrensat;on Insurance Rating Bureau of California. ACs rights reserved From Iho WC$Ras California Wortrars compensation Insurance Forms Manua! 02001 7atg MARKEL INSURANCE COMPANY Installment Endorsement It is hereby agreed and understood that the premium is to be paid on an installment basis as follows; Premium: 5625.00 Fees: S 18.00 Deposit: $643.00 Installments Taxes & Surcharees 1.08/15/2019 $643.00 included If you elect a payment plan, then you will be subject to installment fees for each payment ranging from $3-S 10 depending on the state. If you elect electronic funds transfer, these fees will not apply. This endorsement is effective: 10/22f2019 forms a part of Policy: Iti4 VC0154455-01 Dated: 10/23/2019 Issued to: mediastar inc By: Markel Insurance Company All other terms and conditions or this policy remain unchanged. 8o(9 MWC 1200 05 W WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY UVC 04 03 06 (Ed, 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us ) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be b % of the California workers' compensation premium otherwise due on such remuneration. Work performed by mediastar inc at 702 Mangrove Ave 'Chico, CA 95928-3948 Schedule Subrogant Information Class Code Description CITY OF CARSON 701 E Carson Street 8859 Computer Programming Or Software Development CARSON, CA 90745 This endorsement changes the policy to which it is attached and is effective on the date issued un'ess otherwise stated (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1p12212019 Policy No MWC0154455-01 Insured mediastar inc Insurance Company Markel Insurance Company Countersigned by WC040306 (Ed_ 04-84) 0 1999 by the Workers Compensation insurance Rating 8uroau of Ca:'rfornio AS fights reservad From the WORB's Cakforma Workors' Compensalion tnsumnce FarmsManual9 2001 9of9 Endorsement No Premium (See Attached) Payroll $000