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HomeMy Public PortalAboutC-21-029 - SHI INTERNATIONAL, CORP.DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 AMENDMENT NO. 1 TO AGREEMENT FOR CONTRACT SERVICES THIS AMENDMENT TO THE AGREEMENT FOR CONTRACT SERVICES ("Amendment") by and between the CITY OF CARSON, a California municipal corporation ("City") and SHI INTERNATIONAL, CORP., a New Jersey corporation ("Consultant") is effective as of the 16th day of November, 2021. RECITALS A. City and Consultant entered into that certain Agreement for Contractual Services dated June 1, 2021 ("Agreement") whereby Consultant agreed to provide City with services related to supporting City's electronic mail migration from Exchange 2010 On -Premises to Office 365 Exchange Online. B. On or about August 9, 2021, under City's Contract Officer authority pursuant to Section 1.8 of the Agreement, the Contract Sum was increased by $18,118.94 for extra work performed by Consultant consisting of additional Mimecast features made available to City, thereby increasing the Contract Sum from $437,213 to $455,331.94. C. As part of the services, Consultant and City intended for Consultant to provide Microsoft server and client access licenses for 3 years. D. After entering into the Agreement, Consultant informed City that the $20,229.68 to provide Microsoft server and client access licenses for 3 years in Exhibit C of the Agreement reflects only 1 year of Microsoft server and client access licenses, rather than 3 years, as was intended under the Agreement. E. The City and Consultant agree to increase the Contract Sum by a discounted amount of $23,804.24 to cover the cost of the Microsoft server and client access licenses from October 1, 2021 through January 31, 2024, a period of 2 years and 4 months. F. City and Consultant agree to increase compensation by $23,804.24, for a total Contract Sum of $479,136.18, to cover the cost of the Microsoft server and client access licenses from October 1, 2021 through January 31, 2024, and desire to amend the Agreement accordingly and to ratify and affirm their respective approval of the extra work authorized under Section 1.8 of the Agreement for an amount of $18,118.94. TERMS 1. Contract Changes. The Agreement is amended as provided herein (added text shown in bold italics, deleted text shown in str-ilethr-eugh): A. Section 2.1, "Contract Sum," is hereby amended to read in its entirety as follows: -1- 01007.0001/741733.4 DocuSign Envelope ID: EOE60C45-FDC1-4E6E-95FD-C9FF4D5BD374 "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 Four Hundred Seventy Nine Thousand One Hundred Thirty Six Dollars and Eighteen Cents ($479,136.18437,413.-") Fouf 14un ,.oa rrhift . Seven Thousand Two Hundred rrhiftee Dollars and Zero Cents ($437,213.00) (the "Contract Sum"), unless additional compensation is approved pursuant to Section 1.8." B. Section I. of Exhibit "A," Scope of Services, is hereby ratified, approved and amended to read in its entirety as follows: I. Consultant will perform the following Services: Consultant shall support City in its Exchange 2010 On -Premise to Office 365 Exchange Online Migration ("Services"). City has identified the following goals and objectives in connection with the Services: • Migrate mailboxes from on -premises Exchange 2010 to Office 365 Exchange Online; and • Replace Exchange 2010 server with Exchange Server 2016. The Services are based on the following in -scope environment. Any change to the following in -scope environment details has the potential to affect the overall project scope and therefore the associated fees. Current Environment Location: Users: Resource Mailboxes: Shared Mailboxes: Public Folders: Average Mailbox Size: New Environment Exchange 2010 On -Premises 620 Users 12 Resource Mailboxes 4 Shared Mailboxes 1 Public Folder 2GB (Largest mailbox 30GB) Location: Office 365 Exchange Online The following services will be provided as part of the Services: Plan • Discover and analyze existing Exchange 2010 environment Discover and analyze existing Active Directory environment • Design Azure AD Connect and Exchange Hybrid -2- 01007.0001/741733.4 DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 Build Deploy Support • Design, Plan and Schedule Exchange Hybrid Migration • Create and deliver Design Document • Deploy and Configure Azure AD Connect Server & Synchronization • Build migration batches and synchronize mail for up to 620 total mailboxes • Configure Exchange Online and Hybrid Exchange connectivity • Create and deliver Test Plan Document • Execute Test Plan to validate new environments • Migrate/cutover mailboxes to Office 365 • Cutover Client Access and Mail Flow to Office 365 • Decommission Exchange 2010 and Hybrid Connectivity • Build and deploy Exchange 2016 Management Server • Conduct Knowledge Transfer to Administrator(s) • Create and deliver As -Built Document • Retention and Archive guidance and setup assistance if required • Assistance with SMPT mail flow changes if required Conduct Knowledge Transfer to Administrators, up to 4 hours In connection with Consultant's performance of the foregoing, Consultant shall provide City with the following services and products, identified as Tasks: OFFICE 360 SUBSCRIPTIONS: A. 0365GCCE3 ShrdSvr ALNG SubsVL MVL PerUsr - Year 1 of 3 Microsoft - Part#: AAA -11894; B. 0365GCCE3 ShrdSvr ALNG SubsVL MVL PerUsr - Year 2 of 3 Microsoft - Part#: AAA -11894; C. 0365GCCE3 ShrdSvr ALNG SubsVL MVL PerUsr - Year 3 of 3 Microsoft - Part#: AAA -11894; D. 0365GCCE 1 ShrdSvr ALNG SubsVL MVL PerUsr - Year 1 of 3 Microsoft — Part#: U4S-00002; E. 0365GCCEI ShrdSvr ALNG SubsVL MVL PerUsr - Year 2 of 3 Microsoft — Part#: U4S-00002; -3- 01007.0001/741733.4 DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 F. 0365GCCE1 ShrdSvr ALNG SubsVL MVL PerUsr - Year 3 of 3 Microsoft — Part#: U4S-00002; FI Microsoft - Part#: MQM-00001: AzureActiveDrchyPremPl GCC ShrdSvr ALNG SubsVL MVL (Per User); F2 Microsoft - Part#. MQM-00002: AzureActiveDrctryPremP1 GCC ShrdSvr ALNG Subs VL MVL (Per User); F3 Microsoft - Part#. MQM-00003: AzureActiveDrctryPremP1 GCC ShrdSvr ALNG Subs VL MVL (Per User) MIMECAST SUBSCRIPTIONS: G. Perimeter Defense Plan for 0365 Mimecast - Part#: M PERM -DEF 250 A; H. Mimecast C1 for 0365 Email Security Mimecast - Part#: M C1 -250—A; I. Mimecast Al for 0365 Email Archiving Mimecast - Part#: M Al 250 A J. Add On — Secure Messaging (Per User) for 0365 Mimecast - Part#: MSMPUA K. LCS - Gold for 0365 Email Security Mimecast - Part#: M LCS GD A L. IMP - Managed Implementation Mimecast - Part#: M IlbIP MGD 00 M. Perimeter Defense Plan for 0365 Mimecast — Part#: M PERM -DEF 250 A N. Mimecast C1 for 0365 Email Security Mimecast - Part#: M C1 250 A O. Mimecast Al for 0365 Email Archiving Mimecast - Part#: M Al 250 A P. Add On — Secure Messaging (Per User) for 0365 Mimecast - Part#: M SM PU A Q. LCS - Gold for 0365 Email Security Mimecast - Part#: M LCS GD A R. Perimeter Defense Plan for 0365 Mimecast - Part#: M PERM -DEF 250 A S. Mimecast C1 for 0365 Email Security Mimecast - Part#: M C1 250 A T. Mimecast Al for 0365 Email Archiving Mimecast - Part#: M Al 250 A U. Add On — Secure Messaging (Per User) for 0365 Mimecast - Part#: M_SM PU_A V. LCS - Gold for 0365 Email Security Mimecast - Part#: M LCS GD A -4- 01007.0001n41733.4 DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 W. Mimecast Part #: M_SRE0365_A: Sync and Recover for Exchange and Office 365 X. Mimecast Part #: M LFS PU A: Large file send (per user) SERVER LICENSE: Y. WinSvrDCCore ALNG LicSAPk MVL 16Lic CoreLic - 3 Year Term Microsoft - Part#: 9EA-00271 Z. WinSvrCAL 2019 SNGL MVL UsrCAL Microsoft - Part#: R18-05796 MIGRATION: AA. Office 365 Exchange Migration C. Section I. of Exhibit "C," "Schedule of Compensation," is hereby ratified, approved, and amended to read in its entirety as follows: "I. Consultant shall perform the following tasks at the following rates: MICROSOFT 0365 LICENSES AND MIMECAST RATE QUANTITY SUB -BUDGET EMAIL SECURITY — 3 YEARS A. $212.26 300 $63,678.00 B. $212.26 300 $63,678.00 C. $212.26 300 $63,678.00 D. $76.94 300 $23,082.00 E. $76.94 300 $23,082.00 F. $76.94 300 $23,082.00 Fl. $49.64 1 $49.64 F2. $54.15 1 $54.15 F3. $54.15 1 $54.15 G. $23.08 600 $13,848.00 H. $18.34 600 $11,004.00 I. $29.09 600 $17,454.00 J. $7.11 50 $355.50 K. $3,473.74 1 $3,473.74 L. $1,197.60 1 $1,197.60 M. $23.08 600 $13,848.00 N. $18.34 600 $11,004.00 O. $29.09 600 $17,454.00 P. $7.11 50 $355.50 Q. $3,473.74 1 $3,473.74 R. $23.08 600 $13,848.00 S. $18.34 600 $11,004.00 -5- 01007.0001/741733.4 DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 T. $29.09 600 $17,454.00 U. $7.11 50 $355.50 V. $3,473.74 1 $3,473.74 W. $28.19 600 $16,914 X. $20.94 50 $1,047 SUBTOTAL: $418,002.26399,993.32* MICROSOFT SERVER AND CLIENT ACCESS LICENSES — 3 YEARSFROM 10/1121 THROUGH 1131124 Y. $6,296.48'�� 4 $25,185.92**9,325.68 Z. $47.1224-.2-f 400 $181848.00**904.00 SUBTOTAL: $20,'ry zir69 $44,033.92 Q^20,113.00$443,917.24 OFFICE 365 EXCHANGE MIGRATION AAS'-. Fixed N/A $17,100.00*** SUBTOTAL: $17,100.00 GRAND $4 2700$479,136.18 TOTAL: *Year 1 - $140,131.48134,092.84; 0924; Year 2 - $138,938.39'' 3''�z4; Year 3 - $138,932.391' 2x.'4 **$11,587.84 paid 10/1/21; $16,223.04 paid January 2022; $16,223.04 paid January 2023 ***50% to be invoiced upon Contract execution and 50% to be invoiced upon completion of services." D. Section V. of Exhibit "C," "Schedule of Compensation," is hereby amended to read in its entirety as follows: -6- 01007.0001/741733.4 DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 "V. The total compensation for the Services shall not exceed (Q^37,gi 3.00) ($479,136.18) as provided in Section 2.1 of this Agreement." E. Section I. of Exhibit "D," "Schedule of Performance," is hereby amended to read in its entirety as follows: "I. Consultant shall perform all Services timely in accordance with the following schedule: Days to Deadline Date Perform A. Task AAY- 14 days 14 days from Notice to Proceed B. Tasks A -X 3 years 3 years from execution of Enterprise Agreement and related documentation required by Microsoft C. Tasks Y -Z -X 28 months From 10/1121 through January 31, 2024" 2. Continuing Effect of Agreement. Except as amended by this Amendment, all provisions of the Agreement shall remain unchanged and in full force and effect. From and after the date of this Amendment, whenever the term "Agreement" appears in the Agreement, it shall mean the Agreement, as amended by this Amendment to the Agreement. 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. Each party represents and warrants to the other that there have been no written or oral modifications to the Agreement other than as provided herein. Each party represents and warrants to the other that the Agreement is currently an effective, valid, and binding obligation. Consultant represents and warrants to City that, as of the date of this Amendment, 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, 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. 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. -7- 01007.0001/741733.4 DocuSign Envelope ID: EOE60C45-FDC1-4E6E-95FD-C9FF4D5BD374 5. Authority. The persons executing this Amendment on behalf of the parties hereto warrant that (i) such party is duly organized and existing, (ii) they are duly authorized to execute and deliver this Amendment on behalf of said party, (iii) by so executing this Amendment, such party is formally bound to the provisions of this Amendment, and (iv) the entering into this Amendment does not violate any provision of any other agreement to which said party is bound. 6. Counterparts. This Amendment may be executed in any number of counterparts and each of such counterparts shall for all purposes be deemed to be an original, whether the signatures are originals, electronic, facsimiles or digital. All such counterparts shall together constitute but one and the same Amendment. [SIGNATURES ON FOLLOWING PAGE] • -8- 01007.0001n41733.4 DocuSign Envelope ID: EOE6OC45-FDCt-4E6E-95FD-C9FF4D5BD374 IN WITNESS WHEREOF, the parties hereto have executed this Amendment on the date and year first -above written. CITY: CITY OF CARSON, a municipal corporation a a Davis -Holmes, Mayor ATTEST: Dr. Khaleah K. Bradshaw, APPROVED AS TO FORM: ALESHIRE & WYNDER, LLP Sunny K. Soltani, City Attorney [ndp and rj 1] IA qtr . CONSULTANT: SHI INTERNATIONAL, CORP., a New Jersey corpor�tio�1 ocu ipned by: By: 6Sa�•f,{{�, Avtieu Name: V isa eth Arnold By:rt;aialbr,ontracts Specialist csSit, Name: Cassie Skelton Title: Senior Manager - Contracts Address: 290 Davidson Avenue Somerset, NJ 08873 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. -9- 01007.0001/741733.4 DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 IN WITNESS WHEREOF, the parties hereto have executed this Amendment on the date and year first -above written. ATTEST: Joy Simarago, Deputy City Clerk APPROVED AS TO FORM: ALESHIRE & WYNDER, LLP Sunny K. Soltani, City Attorney [ndp and rjl] CITY: CITY OF CARSON, a municipal corporation Lula Davis -Holmes, Mayor CONSULTANT: SHI INTERNATIONAL, CORP., a New Jersey corpor�tio1 By. jocu iyned by: SAs t �. ava,a(, Name: isa dth Arnold u6rLp,6W- ontracts Specialist By: (ASit, sit an't, Name: Cassie Skelton Title: Senior Manager - Contracts Address: 290 Davidson Avenue Somerset, NJ 08873 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. -9- 01007.0001741733.4 DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. STATE OF CALIFORNIA COUNTY OF LOS ANGELES On , 2021 before me, , personally appeared , proved to me on the basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature: OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. 01007.0001/741733.4 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES DATE OF DOCUMENT OTHER THAN NAMED ABOVE CAPACITY CLAIMED BY SIGNER ❑ INDIVIDUAL ❑ CORPORATE OFFICER TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ❑ ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER SIGNER IS REPRESENTING: (NAME OF PERSON(S) OR ENTITY(IES)) 01007.0001/741733.4 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES DATE OF DOCUMENT OTHER THAN NAMED ABOVE DocuSign Envelope ID: EOE6OC45-FDC1-4E6E-95FD-C9FF4D5BD374 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. STATE OF CALIFORNIA COUNTY OF LOS ANGELES On , 2021 before me, , personally appeared , proved to me on the basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature: OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER ❑ INDIVIDUAL ❑ CORPORATE OFFICER 01007.0001/741733.4 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES DATE OF DOCUMENT [GNER(S) OTHER THAN NAMED ABOVE TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ❑ ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER SIGNER IS REPRESENTING: (NAME OF PERSON(S) OR ENTITY(IES)) 01007.0001/741733.4 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES DATE OF DOCUMENT [GNER(S) OTHER THAN NAMED ABOVE Client#: 38440 SHIINTER1 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01/(MM/DD 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh & McLennan Agency LLC One Executive Drive Somerset, NJ 08873 CONTACT NAME: PHONE FAR A/C, No, Ext): A/C, No): E-MAIL ADDRESS: somersetclsupport@mma-ne.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Fire Insurance Co of Hartford 20478 X INSURED INSURER B: American Casualty Company of Reading PA 20427 SHI International Corp. 290 Davidson Avenue Somerset, NJ 08873 INSURER C: Continental Insurance Co of NJ 42625 INSURER DNational Fire Insurance Co of Hartford 20478 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6050250197 9/30/2021 09/30/2022 EACH OCCURRENCE $1,000,000 CLAIMS -MADE � OCCUR PREMISES To RENTED $11,000,000 MED EXP (Any one person) s15,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO - POLICY JECT LOC PRODUCTS - COMP/OP AGG $ Z,000,OOO $ OTHER: D AUTOMOBILE LIABILITY X X 6050291509 9/30/2021 09/30/202 ED e'II'dan SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED X AUTOS ONLY AUTOS ONLY Ix $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IJ N I A X 650251110 9/30/2021 09/30/2022 X 1sPTATuTE OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Error & Omissions 596831142 9/30/2021 09/30/2022 $6,000,000 OCC/Agg DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carson, its elected and appointed officers, employees, volunteers and agents are included as Additional Insured when required by written contract, agreement or permit, but only with respect to the General Liability and Automobile Liability insurance and subject to the provisions and limitations of the policy. General Liability is written on a primary and non-contributory basis when required by written contract, agreement or permit and subject to the provisions and limitations of the policy. Waiver of (See Attached Descriptions) Cit of Carson APPROVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 701 E Carson Street ^ ACCORDANCE WITH THE POLICY PROVISIONS. Carson, CA 90745 1/19/2022 AUTHORIZED REPRESENTATIVE LUrh•�.(� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S9154745/M9154744 NSJ MJ DESCRIPTIONS (Continued from Page 1) subrogation applies to General Liability and Automobile Liability when required by written contract, agreement or permit and subject to the provisions and limitations of the policy. Waiver of subrogation applies to Workers Compensation when required by written contract, agreement or permit and subject to the provisions and limitations of the policy where permissible by state law. SAGITTA 25.3 (2016/03) 2 of 2 #S9154745/M9154744