HomeMy WebLinkAbout2022 CON Veritone Inc. - Transcription and Redaction SoftwareDo uSign Envelope ID: 8BBDDE'1 - 8E8-4 B3-A33 -1 FF3 4DD E87
SHORT FORM SERVICES AGREEMENT
BY AND BETWEEN
THE CITY OF NATIONAL CITY
AND
VERITONE, INC
THIS AGREEMENT is entered into this 1 ST day of November, 2022, by and between the
CITY OF NATIONAL CITY, a municipal corporation (the "CITY"), and VERITONE, INC., a
corporation (the "CONTRACTOR).
NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services set
forth herein in accordance with the following terms and conditions:
1. Description n of' Services. CONTRACTOR shall provide transcription and
redaction software with customer support. Please see Exhibit "A" for a detail description of the
service that will be provided.
2. Len2th of A reemen . The schedule is set forth below:
The duration of this Agreement is from November, 1 St 2022 through October 3 Pt, 2023.
3. Compensation. The total compensation to CONTRACTOR for providing the
services set forth herein shall not exceed a one-time cost of $17, 750. The compensation for
CONTRACTOR'S work shall be based upon and not exceed the rates given in Exhibit "A" (the
labor rates) without prior written authorization from CITY.
4. Payment Schedule. CITY will make payment within thirty days of receiving
and approving a billing statement for the satisfactorily completed services of CONTRACTOR.
5. Termination. CITY may terminate this Agreement at any time by providing one
(1) day' s written notice to CONTRACTOR.
6. Independent Contractor. It is agreed that CONTRACTOR is an independent
Contractor, and all persons working for or under the direction of CONTRACTOR are
CONTRACTOR' S agents, servants and employees, and said persons shall not be deemed agents,
servants, or employees of CITY.
7. Insurance. CONTRACTOR shall obtain:
A. ri If checked, Professional Liability Insurance (errors and omissions)
with minimum limits of $1,000,000 per occurrence.
B. Automobile insurance covering all bodily injury and property damage
incurred during the performance of this Agreement, with a minimum coverage of $1,000,000
combined single limit per accident. Such automobile insurance shall include owned, non -owned,
and hired vehicles. The policy shall name the CITY and its officers, agents, employees, and
volunteers as additional insureds, and a separate additional insured endorsement shall be provided.
C. Commercial General Liability Insurance, with minimum limits of either
$2,000,000 per occurrence and $4,000,000 aggregate, or $1,000,000 per occurrence and
2,, aggregate with a $2,000,000 umbrella policy, covering all bodily injury and property
damage arising out of its operations, work, or performance under this Agreement. The policy shall
Do uSign Envelope ID: 8BBDDE12-98F8-42B3-A334-1FF824DD6E87
name the CITY and its officers, agents, employees, and volunteers as additional insureds, and a
separate additional insured endorsement shall be provided. The general aggregate limit must apply
solely to this "project" or "location". The "project" or "location" should be noted with specificity
on an endorsement that shall be incorporated into the policy.
D. Workers' compensation insurance in an amount sufficient to meet statutory
requirements covering all of CONTRACTOR'S employees and employers' liability insurance
with limits of at least $1,000,000 per accident. In addition, the policy shall be endorsed with a
waiver of subrogation in favor ofthe CITY. Said endorsement shall be provided prior to
commencement of work under this Agreement.
If CONSULTANT has no employees subject to the California Workers'
Compensation and Labor laws, CONSULTANT shall execute a Declaration to that effect. Said
Declaration shall be provided to CONSULTANT by CITY.
E. The aforesaid policies shall constitute primary insurance as to the CITY, its
officers, ers, employees, and volunteers, so that any other policies held by the CITY shall not contribute
to any loss under said insurance. Said policies shall provide for thirty (30) days prior written notice
to the CITY' s Risk Manager, at the address listed in subsection G below, of cancellation or material
change.
F. Said policies, except for the professional liability and workers'
compensation policies, shall name the CITY and its officers, agents, employees, and volunteers as
additional insureds, and separate additional insured endorsements shall be provided.
G. The Certificate Holder for all policies of insurance required by this Section
shall be:
City of National City
eo Risk Manager
1243 National City Boulevard
National City, CA 91950-4397
H. If required insurance coverage is provided on a "claims made" rather than
"occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years
after expiration of the term (and any extensions) of this Agreement. In addition, the "retro" date
must be on or before the date of this Agreement.
1, Insurance shall be written with only insurers authorized to conduct business
in California which hold a current policy holder's alphabetic and financial size category rating of
not less than ANII according to the current est's Key Rating Guide, or a company of equal
financial stability that is approved by the City's Risk Manager. In the event coverage is provided
by non -admitted "surplus lines" carriers, they must be included on the most recent List of
Approved Surplus Line Insurers "L.ASLI" and otherwise meet rating requirements.
J. This Agreement shall not take effect until certificate(s) or other sufficient
proof that these insurance provisions have been complied with, are filed with, and approved by the
CIT's Risk Manager. If the CONTRACTOR does not keep all insurance policies required by this
Section 7 in full force and effect at all times during the term of this Agreement, the CITY may
treat the failure to maintain the requisite insurance as a breach of this Agreement and terminate the
Agreement as provided herein.
K. All deductibles and self -insured retentions in excess of $10,000 must be
disclosed to and approved by the CITY. CITY reserves the right to modify the insurance
Standard Short Form Agreement
Page 2 of 8 City of National City and
Revised July 2021 VERITONE, INC.
Do u i n Envelope ID: 3BBDDEI -93F -4 63-A334-1 FF824 D E 7
requirements of this Section 7, including limits, based on the nature ofthe risk, prior experience,
insurer, coverage, or other special circumstances.
L. If the CONTRACTOR maintains broader coverage or higher limits (or
both) than the minimum limits shown above, the CITY shall be entitled to the broader coverage or
higher limits (or both) maintained by the CONTRACTOR. Any available insurance proceeds in
excess of the specified minimum limits of insurance and coverage shall be available to the CITY.
8. Indemnification and Hold Harmless. To the maximum extent provided by law, the
CONTRACTOR agrees to defend, indemnify and hold harmless the City of National City, its
officers, officials, agents, employees, and volunteers against and from any and all liability, loss,
damages to property, injuries to, or death of any person or persons, and all claims, demands, suits,
actions, proceedings, reasonable attorneys' fees, and defense costs, of any kind or nature, including
workers' compensation claims, of or by anyone whomsoever, resulting from or arising out of the
CONTRACTOR'S performance or other obligations under this Agreement; provided, however,
that this indemnification and hold harmless shall not include any claims or liability arising from
the established sole negligence or willful misconduct of the CITY, its agents, officers employees,
or volunteers. CITY will cooperate reasonably in the defense of any action, and CONTRACTOR
shall employ competent counsel, reasonably acceptable to the City Attorney.
The indemnity, defense, and hold harmless obligations contained herein shall
survive the termination of this Agreement for any alleged or actual omission, act, or negligence
under this Agreement that occurred during the term of this Agreement.
9. EMPLOYEE PAYMENTS AND INDEMNIFICATION.
IFICATION.
9.1 PERS Eligibility Indemnification. If CONTRACTOR's employee(s) providing
services under this Agreement claims, or is determined by a court of competent jurisdiction or the
California Public Employees Retirement System ("PERS") to be eligible for enrollment in PERS
of the CITY, CONTRACTOR shall indemnify, defend, and hold harmless CITY for the payment
of any employer and employee contributions for PERS benefits on behalf of the employee as well
as for payment of any penalties and interest on such contributions which would otherwise be the
responsibility of the CITY,
CONTRACTOR'S employees providing service under this Agreement shall not: (1)
qualify for any compensation and benefit under PERS; be entitled to any benefits under PERS;
enroll in PERS as an employee of CITY; receive any employer contributions paid by CITY
for PERS benefits; or be entitled to any other PERS-related benefit that would accrue to a CITY
employee. CONTRACTOR's employees hereby waive any claims to benefits or compensation
described in this Section 9. This Section 9 applies to CONTRACTOR notwithstanding any other
agency, state or federal policy, rule, regulation, law or ordinance to the contrary.
9.2 Limitation of CITY Liability. The payment made to CONTRACTOR under this
Agreement shall be the full and complete compensation to which CONTRACTOR and
CONTRACTOR' s officers, employees, agents, and subcontractors are entitled for performance of
any work under this Agreement. Neither CONTRACTOR nor CONTRACTOR' s officers,
employees, agents, and subcontractors are entitled to any salary or wages, or retirement, health,
leave or other fringe benefits applicable to CITY employees. The CITY will not make any federal
Standard Short Form Agreement Page 3 of 8 City of National City and
Revised July 2021 VERITOE, INC.
DoouSign Envelope ID: BBDDEI -98F -4 B -A 4-1 FF8 4DD E 7
or state tax withholdings on behalf of CONTRACTOR, The CITY shall not be required to pay any
workers' compensation insurance on behalf of CONTRACTOR.
9.3 Indemnification for Employee Payments. CONTRACTOR agrees to defend and
indemnify the CITY for any obligation, claim, suit, or demand for tax, retirement contribution
including any contribution to PERS, social security, salary or wages, overtime payment, or
workers' compensation payment which the CITY may be required to make on behalf of(1)
CONTRACTOR, 2 any employee of CONTRACTOR, or any employee of CONTRACTOR
construed to be an employee of the CITY, for work performed under this Agreement. This is a
continuing obligation that survives the termination of this Agreement.
8. Acceptability of Work. . The CITY shall, with reasonable diligence, determine the
quality or acceptability of the work, the manner of performance, and/or the compensation payable
to the CONTRACTOR.
9. Business License, CONTRACTOR must possess or shall obtain business license
from National City Finance D ep artrnent before beginning work.
10. Prevailing Wages. State prevailing wage rates may apply to work performed under
this Agreement. State prevailing wages rates apply to all public works contracts as set forth in
California Labor Code, including but not limited to, Sections 1720, 1720.2, 17 0. , 1 20.4, and
1771. CONTRACTOR is solely responsible to determine if State prevailing wage rates apply and,
if applicable, pay such rates in accordance with all laws, ordinances, rules, and regulations.
11. Administrative Provisions.
A. Computation of Time Periods. If any date or time period provided for in
this Agreement is or ends on a Saturday, Sunday or federal, state or legal holiday, then such date
shall automatically be extended until 5:00 p.m. Pacific Time of the next day which is not a
Saturday, Sunday or federal, state, or legal holiday.
B. Counterparts. This Agreement may be executed in multiple counterparts,
each of which shall be deemed an original, but all of which, together, shall constitute but one and
the same instrument.
C. Captions. Any captions to, or headings of, the sections or subsections of
this Agreement are solely for the convenience of the parties hereto, are not a part of this
Agreement, and shall not be used for the interpretation or determination of the validity of this
Agreement or any provision hereof.
D. No Obligations to Third Parties. Except as otherwise expressly provided
herein, the execution and delivery of this Agreement shall not be deemed to confer any rights upon,
or obligate any of the parties hereto, to any person or entity other than the parties hereto.
E. Exhibits and Schedules. The Exhibits and Schedules attached hereto are
hereby incorporated herein by this reference for all purposes. To the extent any exhibits, schedules,
or provisions thereof conflict or are inconsistent with the terms and conditions contained in this
Agreement, the terms and conditions of this Agreement will control.
F. Amendment to this Agreement. The terms of this Agreement may not be
modified or amended except by an instrument in writing executed by each of the parties hereto.
G. Assignment & Assumption ofRights. CONTRACTOR shall not assign this
Agreement, in whole or in part, to any other party without first obtaining the written consent of
CITY.
Standard Short Form Agreement
Page 4 of 8 City of National City and
Revised July 2021 V RTT0 E, INC.
C oww ign Envelope ID: EBDDE1 - 8F -4 B -A 4-1 FF 24DD E 7
H. Waiver. The waiver or failure to enforce any provision of this Agreement
shall not operate as a waiver of any future breach of any such provision or any other provision
hereof.
I. Applicable Law. This Agreement shall be governed by and construed in
accordance with the laws of the State of California. The venue for any legal action arising under
this Agreement shall be in either state or federal court in the County of San Diego, State of
California. The CONTRACTOR shall comply with all laws, including federal, state, and local
laws, whether now in force or subsequently enacted.
J. Audit. If this Agreement exceeds ten -thousand dollars I , o, the parties
shall be subject to the examination mination and audit of the State Auditor for a period of three years
after final payment under the Agreement, per Government Code Section 8546.7.
K. Entire Agreement. This Agreement supersedes any prior agreements,.
negotiations and communications, oral or written, and contains the entire agreement between the
parties as to the subject matter hereof. No subsequent agreement, representation, or promise made
by either party hereto, or by or to an employee, officer, agent, or representative of any party hereto
shall be of any effect unless it is in writing and executed by the party to be bound thereby.
L. Successors and Assigns. This Agreement shall be binding upon and shall
inure to the benefit of the successors and assigns of the parties hereto.
M. Subcontractors or Stats. The CITY is engaging the services of the
CONTRACTOR identified in this Agreement. The CONTRACTOR shall not subcontract any
portion ofthe work, unless such subcontracting was part of the original proposal or is allowed by
the CITY. In the event any portion of the work under this Agreement is subcontracted, the
subcontractor(s) shall be required to comply with and agree to, for the benefit of and in favor of
the CITY, both the insurance provisions in Section 7 and the indemnification and hold harmless
provision of Section 8 of this Agreement.
N. Construction. The parties acknowledge and agree that i each party is of
equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and
negotiation of this Agreement, iii each such party has consulted with or has had the opportunity
to consult with its own, independent counsel and such other professional advisors as such party
has deemed appropriate, relative to any and all matters contemplated under this Agreement, (iv)
any rule or construction to the effect that ambiguities are to be resolved against the drafting party
shall not apply in the interpretation of this Agreement, or any portions hereof, or any amendments
hereto.
IN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR
on the date and year first above written.
Standard Short Form Agreement
Page 5 of 8 City of National City and
Revised July 2021 VERITONE, INC.
DowSign Envelope CD: 8BBDDE12-98F8-42B3-A334-1FF824DD6E87
CITY OF NATIONAL CITY
By:
Bi
ston, City Manager
APPROVED AS TO FORM:
By:
Barry J. Sc
City Attorney
CONTACT INFORMATION
CITY OF NATIONAL CITY
1243 National City Boulevard
National City, CA 91950-4397
Phone: (619) 336-4510
Fax: (619) 336-4525
Contact: Jose Tellez
Title: Chief of Police
Dep.: Police Department
Email: jtellezanationalcityca.gov
Standard Short Form Agreement
Revised July 2021
VERITONE, 114C.
By:
DocuSigned by:
('Mime
etati44;r:
Jon Gacek
(Print)
GM 0 aiWARE Enterprise
(Ti tie)
By:
(Na me)
(Print)
(Title)
VERITONE,
5291 California Ave. Suite 350
Irvine, CA 92617
Phone: (949) 298-6660
Fax:
Contact: Jon Gacek
Title: GM of aiWARE Enterprise
Email: jgaceWNeritone.com
Taxpayer ID. No.: 47-1161641
Page 6 of 8 c4 of National City and
VERITONE INC.
DocuSign Envelope ID: 8BBDDE12-98F8-42B3-A334-1 FF824DD6E87
EXHIBIT A
LICENSE AGREEMENT
This License Agreement ("Agreement') is entered into as of the date of the last signature below ("Effective Date") by and
between Veritone, Inc, (for itself and/or its subsidiaries), having an office located at 5291 California Ave., Suite 0 , Irvine,
CA 92617 ("Veritone") and the entity listed under Licensee Information below ("Licensee"), with respect to license(s) tt
Veritone's Platform and related Services,
LICENSEE INFORMATION
Agency Name:
National City Police Department
Billing Contact information
Agency Address:
1200 National City Blvd., National City, CA 91950
Contact Name:
Contact Name:
Antonio Ybarra
Contact. Phone..
Phone:
6i 9-336-4487
Contact Email:
Email:
Term:
aybarra@nationalcitvca.gov
Email for Invoices:
10/31/2023
Start Date:
LICENSE AND SERVICES DEMILS
11/1/ o 2 End Date:
Services
Description
License Fees
Illuminate Application
1 aiWARE Platform access
• Veritone Illurninate Application
• Cognitive Processing:
- Includes up to a total of 1,000 hours of Transcription (English)
(with speaker processing during the Term
- Additional hours of such processing will be charged at a rate of
25 per hour of media processed
■ E Users
- Licensee may add additional Illuminate users by submitting a
written request to Veritone (email deemed sufficient). License Fee
will be increased by $1,000.00 for each additional user
$ ,2 0. 0
Redact Application
■ aWARE Platform access
• Veritone Redact Application
• Cognitive Processing:
- Includes up to a total of 100 hours of media uploaded by Licensee
to the Redact Application during the Term
- Additional processing will be charged at a rate of $95.00 per hour
of media uploaded to the Redact Application
$9,500.00
tl
Training and Support:
tandard webinar training and onboarding; technical support via email
-p- _i chat
TERMS AND CONDITIONS
Included
Master License Terms and Conditions. This Agreement is governed by the Veritone Master License erjy and
C onc�l tior _ ( LC) at httos:/lunlock.veritorr .com license -terms- I (the "Terms and Conditions"), which are
incorporated herein by reference. In the event of any conflict or inconsistency between the provisions of this
Agreement and the provisions contained in the Terms and Conditions, the provisions of this Agreement shall govern
and control. Capitalized terms used but not defined herein shall have the meanings ascribed to them in the Terms and
Conditions.
Applications and Cognitive Processing. During the Term, Veritone will provide Licensee with access to the Applications
and associated cognitive processing specified above. Cognitive processing will be via an automated process within the
Platform. Cognitive processing in the Illuminate Application will be calculated based on the hours of media processed
by a single cognitive engine in each cognitive category specified above. Licensee will be responsible for uploading
media in a format reasonably required by Veritone in order to ingest and process the media through the Applications.
Standard Short Form Agreement
Revised July 2021
Page 7 101'8 City of National City and
VERITONE, l`".
DoouSign Envelope ID: 88BDDE12-98F8--42B3-A334-1 FF824DD6E87
Licensee represents and warrants that it has the right to furnish to Veritone and to use such media in connection with
Licensee's use of the Platform and Services.
Limitations. Licensee acknowledges that the Redact Application is intended to be used by Licensee only as a tool to
support review and redaction of video footage, and the Redact Application and the results generated therefrom should
not be considered or relied upon as a substitute for Licensee's customary review and redaction procedures. Licensee
acknowledges that there are inherent (limitations in artificial intelligence technologies, and Veritone makes no
representations or warranties as to the accuracy, quality, sufficiency or usefulness of the results generated by the
Redact Application, Licensee is solely responsible for verifying all results generated by the Redact Application as part
of its customary review and redaction procedures.
Payment Terms. The License Fees will be invoiced upon execution of this, Agreement and will be due and payable upon
receipt of invoice. Thereafter, subject to credit approval, Veritone will submit invoices on a monthly basis for the
additional processing fees incurred during the previous month, and/or the additional License Fee for users added during
the previous month (if any), and such invoices will be due and payable by the first day of the month following the invoice
date. Notwithstanding the foregoing, if the total additional processing fees incurred during a calendar month are less
than $50.00, Veritone may, in its sole discretion, delay invoicing of such additional processing fees until the total
additional processing fees incurred but not yet invoiced exceed $50.00. All amounts are stated and payable in U.S.
dollars.
Authority. The person executing this Agreement on behalf of each party represents and warrants that he or she has
full authority to execute the same on behalf of such party, and that no other actions or approvals are required for such
party to enter into this Agreement and perform its obligations hereunder.
_ _
VERITONE, INC.
''^' Ile' .y;
ACCEPTED AND
AGREED BY:
LICENSEE
Signature:
31�1
2C314 C81
2.
=1grkature:
1CC
Name:
Name:
Title;
1v1, ai WARE En
p `i e
Title;
Date:
12/16/2022I 1:
U 56
m PSI
Date{
Standard Short Form Agreement
DS
V5RITONE,
inTONE FINANCE
APPROVED
Page 8 of 8 City of National City and
Revised July 2021 VERITONE, INC.
v VERITONE..
VERITONE, INC.
575 Anton Boulevard, Suite 100
Costa Mesa, California 92526
(888) 507-1737
www.veritone.corn
November 2021
Re: Veritone aiWARETM Operating System and Applications
To whom it may concern:
This confirms that Veritone, Inc. ("Veritone") is the developer and provider of a i +'' RET '1, a proprietary
artificial intelligence (Al) operating system, the proprietary applications built on aiWARE, including the
Veritone !Dentify, Illuminate and Redact applications, and related cognitive processing, analytics and
other services. Veritone licenses aiW, RE and associated applications and services through software -as-
a -service (SaaS), on -premises and hybrid deployment models.
If you have any questions, please contact Veritone at info@vertone.com or (888) 507-1737.
► T.,,PK .. CERTIFiCATE
ii,.......------
'
OF
LIABILITY
INSURANCE
I]
06/14/2022
W\
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NLYAND 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
If SUBROGATION IS WAIVED, subject
this certificate does not confer rights
is an ADDITIONAL INSURED, the polio (ie) must have ADDITIONAL INSURED provisions or be endorsed.
to the terms and conditions of the policy, certain policies may require an endorsement A statement on
to the certificate holder in lieu of such endorsement(s).
PRODUCER
Liberty Company Insurance Brokers
Lic 140079653
5955 De Soto Ave, Ste 250
Woodland Hills CA 91367
r�T��
j1Th Tami Van Ert
NAMThe
PHONE (888) 918-3960
(Al , No, -Ex ,-
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(A/C, vio):
E-MAIL tvanert@libertycompany.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER : BerkFey National Insurance Company
38911
INSURED
Veritone, Inc. et al per addendum attached
2420 17th Street, 3rd Floor
Denver, CO 80202
INSURER B : Indian Harbor Insurance
36940
INSURER O : AA XL
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 22-23 GLAUWCCYB 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. NOTVVITHSTANDING 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.
ILTR
TYPE OF INSURANCE
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POLICY NUMBER �
POLICY EFF
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1MMiDDIYYYY
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COMMERCIAL GENERAL LIABILITY
T P7012737-14
06111/2022
06/11/2023
EACH OCCURRENCE
1r000,000
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1,000,00
CLAIMS -MADE
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PERSONAL & ADV INJURY
$ 1,0000000
GENERAL AGGREATE
2,000,000
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AGGREGATE LIMITAPPLIES PER:
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AUTOMOBILE LIABILITY
T P701 737-14
06/11/2022
06/11/2023
COMBINED SINGLE LIMIT
(Ea accident) -_-..
1,000,000
BODILY INJURY (Per person)
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ANY AUTO
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$
OWNED
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$ SCHEDULED
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$
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06/1112022
06/11/202
EACH OCCURRENCE
10,000,000
AGGREGATE ANTE
10,000 000
EXCESS LIAR
CLAIMS -MADE
DEC}
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ANY PROPRIETOR/PARTNER/EXECUTIVE
FFIDEPIMEMIEER EXCLUDED?
+
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1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
100000000
B
Cyber Liability/TechnologyProducts and
Services - Claims Made
MTF9043631 01
06/ 11/2022
06/11/2023
Aggregate
Retention -Per Claim
Full Prior Acts
,000,000
$250,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
CANCELLATION
Evidence of Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
i lJJ1.1\1A
ACORD 25 (2016/03)
1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Form 1111-9
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
identification Number and Certification
Go to wvvvvirs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
a)
(73
a
C
6 C
a o
41
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c
67
CD
EL
Ca
g
1 Name (as shown on your income tax return). Name is required on this line: do not leave this line blank.
Veritone Inc.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1, Check only one of the
following seven boxes.
El Individual/sole proprietor or
sincrle-member LLC
El Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, F'=Partnership) 0
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
El Other (see instructions)*
C Corporation U S Corporation El Partnership El Trust/estate
5 Address (number, street, and apt+ or suite not) See instructions.
2420 17th Street, 3rd FlOor
6 City, state, and ZiP code
Denver, CO 80202
7 List account number(s) here (optional)
Part I
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Appifs to accounts rnatntaineri outside the ILS.)
Requester's name and address (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
or
Employer identification number
Certification
7
1
1
6
4
1
Under penalties of perjury, I certify that;.
1, The number shown on this form is my correct taxpayer identification number (or I any waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, cr (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (d) the 1RS has notified me that 1 am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Ii, later.
Sign
Here
Signature of
U.S. person. it
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form 1-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An 'individual or entity, (Form W-9 requester) who is required to file an
information return with the iRS must obtain yourcorrect taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITN, adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
D ate • , /[04 1C26 9
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1 099-MISC (various types of income, prizes, awards, or gross
proceeds)
▪ Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-i (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1 098-T (tuition)
• Form 1099- (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a. resident
alien), to provide your correct TIN.
if you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231
Form - 9 (Rev. 10-2018)
Form W-9 (Rev. 10-2018) Page
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting, is correct. See What is
FATCA reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other
than Form W-9 to request your TIN, you must use the requester's form if
it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United Slates are generally required to pay a withholding
tax under section 1446 on any foreign partners' share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 withholding tax. Therefore, if you are a U.S. person
that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
• In the case of a U.S, trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a "saving clause." Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 19 4) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States, A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W 9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the iR 24% of such
payments. This is called "backup withholding." Payments that may be
subject to backup withholding include interest, tax-exempt interest,
dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, payments made in settlement of payment card and
third party network transactions, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN! make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for
Part II for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are riot subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information,
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person, For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. if you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $ 0 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Form W-9 (Rev. 10-2018)
Page
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1 a. This should also be the same as the
name you entered on the Form 1040/1040AN1049EZ you filed with your
application.
b. Sole proprietor or single -member Li.,,. Enter your individual
name as shown on your 1040/1040A/1040EZ on line 1. You may enter
your business, trade, or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single -member LLC, C
corporation, or S corporation. Enter the entity's name as shown on the
entity's tax return on line 1 and any business, trade, or DBA name on
line 2.
d. Other entities. Enter your name as shown on required U.S. federal
tax documents on line 1. This name should match the name shown on the
charter or other legal document creating the entity. You may enter any
business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a
"disregarded entity." See Regulations section 01.7701-2(c)(2)(iii). Enter
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the
name shown on the income tax return on which the income should be
reported. For example, if a foreign LLC that is treated as a disregarded
entity for U.S. federal tax purposes has a single owner that is a U.S.
person, the U.S. owner's name is required to be provided on line 1, if
the direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, "Business name/disregarded entity
name," If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. Tint.
Line
If you have a business name, trade name, DBA name, or disregarded
entity name, you may enter it on line 2.
Line
Check the appropriate box on line 3 for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3.
IF the entity/person on line 1 is
THEN check the box for .
• Corporation
Corporation
Individual
Sole proprietorship, or
• Single -member limited liability
'company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
Individual/sole proprietor or single-
member LLC
LLC treated as a partnership for
U.S. federal tax purposes,
• LLC that has filed Form 8832 or
2553 to be taxed as a corporation,
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.
Limited liability company and enter
the appropriate tax classification. '
(P= Partnership; C= C corporation;
or S= S corporation)
• Partnership
Partnership
• Trust/estate
Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from
backup withholding,
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to
attorneys' fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 01(a), any IRA, or
a custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f ( )
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.B. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies,
or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S, commonwealth or
possession
7—A futures commission merchant registered with the Commodity
Futures Trading Commission
8-A8—A real estate investment trust
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940
10—A common trust fund operated by a bank under section 4(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section
4947
Form W-9 (Rev. 10- 018)
Page 4
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 1.
IF the payment Is for ... i
THEN the payment is exempt
for...
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
Barter exchange transactions and
patronage dividends
Exempt payees 1 through 4
Payments over $600 required to be
reported and direct sales over
$5,0001
Generally, exempt payees
1 through 52
Payments made in settlement of
payment card or third party network
transactions
Exempt payees 1 through 4
See Form 1099-MIS, Miscellaneous Income, and its instructions.
2 However, the following payments made to a corporation and
reportable on Form 1099-MISC are rot exempt from backup
withholding: medical and health care payments, attorneys' fees, gross
proceeds paid to an attorney reportable under section 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or
any similar indication) written or printed on the line for a FATCA
exemption code.
A —An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(7)
B—The United States or any of its agencies or instrumentalities
—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United
States or any state
--A real estate investment trust
H—A regulated investment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment
Company Act of 1940
I —A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section
4 47(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g)
plan
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Lines
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box, If you do not have an ITIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN.
If you are a single -member LLC that is disregarded as an entity
separate from its owner, enter the owner's SSN (or Ell , if the owner has
one). Do riot enter the disregarded entity's EIN, If the LLC is classified as
a corporation or partnership, enter the entity's EiN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form -, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSAgov. You may also get this form by calling 1- 00-772-121 .
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EiN. You can apply for an EIN
online by accessing the IRS website at vuww,irs. o /Bu ine ses and
clicking on Employer identification Number (EIN) under Starting a
Business. Go to www.irs.gov/Forms to view, download, or print Form
W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to
place an order and have Form W-7 and/or -4 mailed to you within 10
business days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and write "Applied For" in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, generally you will have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to other types of payments,
You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering "Applied For" means that you have already applied for a
TIN or that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 6 below.
Form W-9 (Rev. 10-2018)
Page
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TiN, but you do not have to sign the
certification.
2.1nterest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. `Other payments" include
payments made in the course of the requester's trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 9), ABLE accounts (under section 529A),
iRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
2. Two or more individuals (joint
account) other than an account
maintained by an FF1
3. Two or more I.J.B. persons
(joint account maintained by an FF1)
4. Custodial account of a minor
(Uniform Gift to Minors Act)
5. a. The usual revocable savings trust
(grantor is also trustee)
b. So-called trust account that is not
a legal or valid trust under state law
6. Sole proprietorship or disregarded
entity owned by an individual
7. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1.071-4(b)()(i)
(A))
The individual
The actual owner of the account or, if
combined funds, the first individual on
the accunt1
Each holder of the account
The minor2
The grantor -trustees
The actual owners
The owner3
The grantor*
For this type of account:
Give name and EIN of:
8 Disregarded entity not owned by an
individual
9 A valid trust, estate, or pension trust
10, Corporation or LLC electing
corporate status on Farm 8832 or
Form 2553
11 Association, club, religious,
charitable, educational, or other tax-
exempt organization
1. Partnership or multi -member LLC
13. A broker or registered nominee
The owner
Legal entity4
The corporation
The organization
The partnership
The broker or nominee
For this type of account:
Give name and EIN of:
14, Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
15. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1. 71-4(b)( )()(B))
The public entity
The trust
1 List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
2 Circle the minor's name and furnish the minor's SSN.
3 You must show your individual name and you may also enter your
business or DBA name on the "Business name/disregarded entity"
name line. You may use either your SSN or EIN (if you have one), but the
IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do
rot furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.) Also see Special
rules for partnerships, earlier.
*Note: The grantor also must provide a Form W-9 to trustee of trust.
Note: if no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information
such as your name, SSN, or other identifying information, without your
permission, to commit fraud or other crimes. An identity thief may use
your SSN to get a job or may file a tax return using your SSN to receive
a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity or credit report, contact the IRS Identity Theft Hotline
at 1-800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You car reach TAS by
calling the TAS toll -free case intake line at 1-877-777-4778 or TTY/TDD
1-00- -40 9.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business eniails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
Form W-9 (Rev. 10-2018) Page
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800- 66-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/com 1a!nt. You can
contact the FTC at www. ftc.govlidtheft or 877-1DTHEFT (7 -4 -4 8).
If you have been the victim of identity theft, see www.identityTheft.gov
and Pub. 5027,
Visit www.irs. ov/ldentftyneft to learn more about identity theft and
how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an IRA, Archer MS, or HS. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their laws. The information also may be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism, You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information,
i
v VERITONE.
LICENSE AGREEMENT
This License Agreement ("Agreement") is entered into as of the date of the last signature below ("Effective Date".) by and between
Veritone, Inc. (for itself and/or its subsidiaries), having an office located at 5291 California Ave., Suite 300, Irvine, CA 92617 ("Veritone")
and the entity listed under Licensee Information below ("Licensee"), with respect to license(s) to Veritone's Platform and related
Services.
LICENSEE INFORMATION
Department
Billing Contact Information
Agency Name:
National City Police
Agency Address:
1200 National City Blvd., National City, CA 91950
Contact Name:
Contact Name:
Antonio Ybarra
Contact Phone:
Phone:
619-336-4487
Contact Email:
Email:
Term::
aybarra@nationalcityca.gov
Email for Invoices:
End Date` 8/14/ 0 3
Start Date:
LICENSE AND SERVICES DETAILS
8/15/2022
Services
Description
License Fees
Illuminate
Application
• aiWARE Platform access $8,250.00
' Veritone Illuminate Application
Cognitive Processing:
- Includes up to a total of 1,000 hours of Transcription (English)
(with speaker separation) processing during the Term
- Additional hours of such processing will be charged at a rate of
$2.25 per hour of media processed
6 Users
- Licensee may add additional Illuminate users by submitting a
written request to Veritone (email deemed sufficient). License
Fee will be increased by $1,000.00 for each additional user
Redact Application
0 aiWARE Platform access $9 500.00
13 Veritone Redact Application
. Cognitive Processing:
- Includes up to a total of 100 hours of media uploaded by Licensee
to the Redact Application during the Term
- Additional processing will be charged at a rate of $5.00 per hour
of media uploaded to the Redact Application
Training and Support
Standard webinartr°aining and onboarding; technical
and chat
TERMS AND CONDITIONS
support via email
included
1. Master License Terms andConditions. This Agreement is governed by the Veritone Master License Terms and Conditions (LC) at
https:J/unlock,veritone.com/license-terms- lc (the "Terms and Conditions"), which are incorporated herein by reference. In the
event of any conflict or inconsistency between the provisions of this Agreement and the provisions contained in the Terms and
Conditions, the provisions of this Agreement shall govern and control. Capitalized terms used but not defined herein shall have the
meanings ascribed to them in the Terms and Conditions.
Applications and Cognitive Processing. During the Term, Veritone will provide Licensee with access to the Applications and
associated cognitive processing specified above. Cognitive processing will be via an automated process within the Platform.
Cognitive processing in the Illuminate Application will be calculated based on the hours of media processed by a single cognitive
engine in each cognitive category specified above. Licensee will be responsible for uploading media in a format reasonably required
by Veritone in order to ingest and process the media through the Applications. Licensee represents and warrants that it has the right
to furnish to Veritone and to use such media in connection with Licensee's use of the Platform and Services.
Limitations, Licensee acknowledges that the Redact Application is intended to be used by Licensee only as a too! to support review
and redaction of video footage, and the Redact Application and the results generated therefrom should not be considered or relied
upon as a substitute for Licensee's customary review and redaction procedures, Licensee acknowledges that there are inherent
limitations in artificial intelligence technologies, and Veritone makes no representations or warranties as to the accuracy, quality,.
sufficiency or usefulness of the results generated by the Redact Application. Licensee is solely responsible for verifying all results
generated by the Redact Application as part of its customary review and redaction procedures.
4. Payment Terms. The License Fees will be invoiced upon execution of this Agreement and will be due and payable upon receipt of
invoice. Thereafter, subject to credit approval, Veritene will submit invoices on a monthly basis for the additional processing fees
incurred during the previous month, and/or the additional License Fee for users added during the previous month Of any), and such
invoices will be due and payable by the first day of the month following the invoice date. Notwithstanding the foregoing, if the total
additional processing fees incurred during a calendar month are less than $50.00, Veritone may, in its sole discretion, delay invoicing
of such additional processing fees until the total additional processing fees incurred but not yet invoiced exceed $5O O0. All amounts
are stated and payable in U.S, dollars.
5. Authority. The person executing this Agreement on behalf of each party represents and warrants that he or she has full authority
to execute the same on behalf of such party, and that no other actions or approvals are required for such party to enter into this
Agreement and perform its obligations hereunder.
ACCEPTED AND
'ERITONE, INC.
AGREED BY:
LICENSEE
Signature:
Signature:
Name:
Name:
Title'
Title:
Date.
Date: