Loading...
HomeMy WebLinkAboutTETRA TECH (2)dSURANCE NOT ON FILE NORK MAY.NQT PROCEED APR 4 7 2021 CLERK OF COUNCIL DATE: A-2021-035-01 FIRST AMENDMENT TO AGREEMENT TO PROVIDE ON -CALL O Ph1A (A)Lf✓MAn� WATER RESOURCES ENGINEERING SERVICES (TETRA TECH) THIS FIRST AMENDMENT to the above -referenced agreement is entered into on March 16, 2021, by and between Tetra Tech ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. Following the City's issuance of Request for Proposal No. 19-100, the parties entered into Agreement No. A-2020-075-01, dated April 21, 2020, by which Contractor agreed to provide on -call water resources engineering services for the City's Public Works Agency ("Agreement"). B. Contractor was one of eight contractors selected to provide services on an as -needed basis under RFP No. 19-100. The total compensation for services provided by all contractors selected under RFP No. 19-100 was not to exceed a shared aggregate amount of $2,000,000 during the term of the Agreement, including any extension periods. C. The Agreement remains in effect through April 21, 2023, with provision for extension, and the parties now wish to amend the Agreement to increase the maximum shared aggregate expenditure under the Agreement. The Parties therefore agree: 1. Section 2.a., Compensation, is amended to increase the total compensation for services provided by all contractors selected under RFP No. 19-100 by the shared aggregate amount of $950,000 during the term of the Agreement, including any extension periods. 2. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. aisy Gomez Kristine Ridge Clerk of the Council City Manager signatures continue on next page - Page 1 of 2 A-2021-035-01 APPROVED AS TO FORM SONIA R. CARVALHO City Attorney sy: W�:: 1w �.,..E. J6fin M.Funk Sr. Assistant City Attorney RECOMMENDED FOR APPROVAL Nabil Saba Executive Director Public Works Agency CONTRACTOR �e�Ta lec1n Name: tarn EPeecsvn, p.E, Title: vlee Pres��eri�' Page 2 of 2 Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! Ebuf;!3132/21/17!19;19;27! Upsj!Qjfstpo .18(11( !EBUF)NN0EE0ZZZZ*!!!!!!!! !1:03803132 DFSUJGJDBUF!PG!MJBCJMJUZ!JOTVSBODF UIJT!DFSUJGJDBUF!JT!JTTVFE!BT!B!NBUUFS!PG!JOGPSNBUJPO!POMZ!BOE!DPOGFST!OP!SJHIUT!VQPO!UIF!DFSUJGJDBUF!IPMEFS/!UIJT! DFSUJGJDBUF!EPFT!OPU!BGGJSNBUJWFMZ!PS!OFHBUJWFMZ!BNFOE-!FYUFOE!PS!BMUFS!UIF!DPWFSBHF!BGGPSEFE!CZ!UIF!QPMJDJFT! CFMPX/!UIJT!DFSUJGJDBUF!PG!JOTVSBODF!EPFT!OPU!DPOTUJUVUF!B!DPOUSBDU!CFUXFFO!UIF!JTTVJOH!JOTVSFS)T*-!BVUIPSJ\[FE! SFQSFTFOUBUJWF!PS!QSPEVDFS-!BOE!UIF!DFSUJGJDBUF!IPMEFS/ JNQPSUBOU;!Jg!uif!dfsujgjdbuf!ipmefs!jt!bo!BEEJUJPOBM!JOTVSFE-!uif!qpmjdz)jft*!nvtu!ibwf!BEEJUJPOBM!JOTVSFE!qspwjtjpot!ps!cf!foepstfe/!Jg! TVCSPHBUJPO!JT!XBJWFE-!tvckfdu!up!!!uif!ufsnt!boe!dpoejujpot!pg!uif!qpmjdz-!dfsubjo!qpmjdjft!nbz!sfrvjsf!bo!foepstfnfou/!B!tubufnfou!po!uijt! dfsujgjdbuf!epft!opu!dpogfs!sjhiut!up!uif!dfsujgjdbuf!ipmefs!jo!mjfv!pg!tvdi!foepstfnfou)t*/ DPOUBDU QSPEVDFS OBNF; QIPOF GBY )B0D/!Op/!Fyu*; )B0D/!Op/*; F.NBJM BEESFTT; JOTVSFS)T*!BGGPSEJOH!DPWFSBHFOBJD!$ JOTVSFE JOTVSFS!B; JOTVSFS!C; JOTVSFS!D; JOTVSFS!E; JOTVSFS!F; JOTVSFS!G; 68119:644282 DPWFSBHFTDFSUJGJDBUF!OVNCFS;SFWJTJPO!OVNCFS; UIJT!JT!UP!DFSUJGZ!UIBU!UIF!QPMJDJFT!PG!JOTVSBODF!MJTUFE!CFMPX!IBWF!CFFO!JTTVFE!UP!UIF!JOTVSFE!OBNFE!BCPWF!GPS!UIF!QPMJDZ!QFSJPE! JOEJDBUFE/!OPUXJUITUBOEJOH!BOZ!SFRVJSFNFOU-!UFSN!PS!DPOEJUJPO!PG!BOZ!DPOUSBDU!PS!PUIFS!EPDVNFOU!XJUI!SFTQFDU!UP!XIJDI!UIJT! DFSUJGJDBUF!NBZ!CF!JTTVFE!PS!NBZ!QFSUBJO-!UIF!JOTVSBODF!BGGPSEFE!CZ!UIF!QPMJDJFT!EFTDSJCFE!IFSFJO!JT!TVCKFDU!UP!BMM!UIF!UFSNT-! FYDMVTJPOT!BOE!DPOEJUJPOT!PG!TVDI!QPMJDJFT/!MJNJUT!TIPXO!NBZ!IBWF!CFFO!SFEVDFE!CZ!QBJE!DMBJNT/ Mjnjut!tipxo!bsf!bt!sfrvftufe JOTS!BEEM!TVCSQPMJDZ!FGG!QPMJDZ!FYQ! !UZQF!PG!JOTVSBODFQPMJDZ!OVNCFS!MJNJUT MUSJOTEXWE)NN0EE0ZZZZ*)NN0EE0ZZZZ* B DPNNFSDJBM!HFOFSBM!MJBCJMJUZ YFBDI!PDDVSSFODF EBNBHF!UP!SFOUFE! DMBJNT.NBEFPDDVS Y QSFNJTFT!)Fb!pddvssfodf* NFE!FYQ!)Boz!pof!qfstpo* Y Y-D-V!Dpwfsbhf QFSTPOBM!'!BEW!JOKVSZ HFOFSBM!BHHSFHBUF HFO(M!BHHSFHBUF!MJNJU!BQQMJFT!QFS;! QSP. YY QPMJDZMPD QSPEVDUT!.!DPNQ0PQ!BHH KFDU PUIFS; B DPNCJOFE!TJOHMF!MJNJU BVUPNPCJMF!MJBCJMJUZ )Fb!bddjefou* CPEJMZ!JOKVSZ!)!Qfs!qfstpo* BOZ!BVUP Y TDIFEVMFE CPEJMZ!JOKVSZ!)Qfs!bddjefou* PXOFE! !BVUPT BVUPT!POMZ QSPQFSUZ!EBNBHF OPO.PXOFE! IJSFE!BVUPT! )Qfs!bddjefou* BVUPT!POMZ POMZ E FBDI!PDDVSSFODF Y Y VNCSFMMB!MJBC PDDVS! BHHSFHBUF DMBJNT.NBEF FYDFTT!MJBC Y EFE! SFUFOUJPO BXPSLFST!DPNQFOTBUJPO!BOE! QFS!TUBUVUF PUI. Y FS FNQMPZFST(!MJBCJMJUZ C Z!0!O BOZ!QSPQSJFUPS!0!QBSUOFS!0!FYFDVUJWF! F/M/!FBDI!BDDJEFOU O O!0!B PGGJDFS0NFNCFS!FYDMVEFE@ F/M/!EJTFBTF.FB!FNQMPZFF )Nboebupsz!jo!OI* Jg!zft-!eftdsjcf!voefs! F/M/!EJTFBTF.QPMJDZ!MJNJU EFTDSJQUJPO!PG!PQFSBUJPOT!cfmpx D EFTDSJQUJPO!PG!PQFSBUJPOT!0!MPDBUJPOT!0!WFIJDMFT!)BDPSE!212-!Beejujpobm!Sfnbslt!Tdifevmf-!nbz!cf!buubdife!jg!npsf!tqbdf!jt!sfrvjsfe* DFSUJGJDBUF!IPMEFSDBODFMMBUJPO TIPVME!BOZ!PG!UIF!BCPWF!EFTDSJCFE!QPMJDJFT!CF!DBODFMMFE!CFGPSF!UIF! FYQJSBUJPO!EBUF!UIFSFPG-!OPUJDF!XJMM!CF!EFMJWFSFE!JO!BDDPSEBODF!XJUI!UIF! QPMJDZ!QSPWJTJPOT/ BVUIPSJ\[FE!SFQSFTFOUBUJWF ª2:99.3126!BDPSE!DPSQPSBUJPO/!Bmm!sjhiut!sftfswfe/ BDPSE!36!)3127014* Uif!BDPSE!obnf!boe!mphp!bsf!sfhjtufsfe!nbslt!pg!BDPSE Additional Insured – Owners, Lessees Or Contractors – Ongoing Operations – Scheduled Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l. PremReturn Prem. GLO1817406-010/01/2010/01/20210/01/2075272000N/AN/A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Location and Description ofAdditional Name of Person or Organization: Ongoing Operations:Premium: Any person or organization to whom or to which you Any location or project, other than a wrap-up or other N/A are required to provide additional insured status in a consolidated insurance program location or project written contract or written agreement executed prior for which insurance is otherwise separately provided to the loss, except where such contract or agreement to you by a wrap-up or other consolidate insurance is prohibited by law. program. A.Section II –Who Is An Insuredis amended to include as an insured anyperson or organization shown in the Scheduleof this endorsement, but only with respect to liability arising out of your ongoing operations performed for that insuredator from thecorresponding location designated and described in the Schedule. However, if you have entered into a construction contract with an additional insured person or organization shown in the Schedule of this endorsement, the insurance afforded to such additional insured only applies to the extent permitted by law. B.With respect to the insurance afforded to anyadditional insuredshown in the Schedule of this endorsement, the following additional exclusionapplies: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. All other terms and conditions of this policy remain unchanged. U-GL-1465-DCW(12-13) Page 1of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Additional Insured – Owners, Lessees Or Contractors – Completed Operations – Scheduled Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l. PremReturn Prem. GLO1817406-010/01/2010/01/20210/01/2075272000N/AN/A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Location and Description ofAdditional Name of Person or Organization: CompletedOperations:Premium: Any person or organization to whom or to which you Any location or project, other than a wrap-up or other N/A are required to provide additional insured status in a consolidated insurance program location or project written contract or written agreement executed prior for which insurance is otherwise separately provided to the loss, except where such contract or agreement to you by a wrap-up or other consolidate insurance is prohibited by law. program. Section II –Who Is An Insuredis amended to include as an insured anyperson or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of "your work" at or from the corresponding location designated and described in the Schedule performed for that insured and included in the "products-completed operations hazard". However, if you have entered into a construction contract with anadditional insured person or organization shown in the Schedule of this endorsement,the insurance afforded to such additional insured only applies to the extent permitted by law. All other terms and conditions of this policy remain unchanged. U-GL-1466-DCW(12-13) Page 1of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. QPMJDZ!OVNCFS;!DPNNFSDJBM!HFOFSBM!MJBCJMJUZ! !DH!36!14!16!1:! ! UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/!!QMFBTF!SFBE!JU!DBSFGVMMZ/! EFTJHOBUFE!DPOTUSVDUJPO!QSPKFDU)T*!! HFOFSBM!BHHSFHBUF!MJNJU! Uijt!foepstfnfou!npejgjft!jotvsbodf!qspwjefe!voefs!uif!gpmmpxjoh;!! ! DPNNFSDJBM!HFOFSBM!MJBCJMJUZ!DPWFSBHF!QBSU!! ! TDIFEVMF! ! Eftjhobufe!Dpotusvdujpo!Qspkfdu)t*;! B!HFOFSBM!BHHSFHBUF!MJNJU!BQQMJFT!UP!FBDI!DPOTUSVDUJPO!QSPKFDU!XIFSF!! UIF!OBNFE!JOTVSFE!JT!QFSGPSNJOH!PQFSBUJPOT-!IPXFWFS-!B!HFOFSBM!!!!!!!! BHHSFHBUF!MJNJU!EPFT!OPU!BQQMZ!UP!BOZ!DPOTUSVDUJPO!QSPKFDU!XIFSF!UIF!! OBNFE!JOTVSFE!JT!QFSGPSNJOH!PQFSBUJPOT!UIBU!BSF!JOTVSFE!VOEFS!B!XSBQ!! VQ!PS!BOZ!PUIFS!DPOTPMJEBUFE!PS!TJNJMBS!JOTVSBODF!QSPHSBN/!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Jogpsnbujpo!sfrvjsfe!up!dpnqmfuf!uijt!Tdifevmf-!jg!opu!tipxo!bcpwf-!xjmm!cf!tipxo!jo!uif!Efdmbsbujpot/! ! ! B/!Gps!bmm!tvnt!xijdi!uif!jotvsfe!cfdpnft!mfhbmmz!!4/!Boz!qbznfout!nbef!voefs!Dpwfsbhf!B!gps! pcmjhbufe!up!qbz!bt!ebnbhft!dbvtfe!cz!ebnbhft!ps!voefs!Dpwfsbhf!D!gps!nfejdbm! #pddvssfodft#!voefs!Tfdujpo!J!....!Dpwfsbhf!B-!boe!fyqfotft!tibmm!sfevdf!uif!Eftjhobufe! gps!bmm!nfejdbm!fyqfotft!dbvtfe!cz!bddjefout!Dpotusvdujpo!Qspkfdu!Hfofsbm!Bhhsfhbuf!Mjnju! voefs!Tfdujpo!J!....!Dpwfsbhf!D-!xijdi!dbo!cf!gps!uibu!eftjhobufe!dpotusvdujpo!qspkfdu/!Tvdi! buusjcvufe!pomz!up!pohpjoh!pqfsbujpot!bu!b!tjohmf!qbznfout!tibmm!opu!sfevdf!uif!Hfofsbm! eftjhobufe!dpotusvdujpo!qspkfdu!tipxo!jo!uif!Bhhsfhbuf!Mjnju!tipxo!jo!uif!Efdmbsbujpot!ops! Tdifevmf!bcpwf;!tibmm!uifz!sfevdf!boz!puifs!Eftjhobufe! Dpotusvdujpo!Qspkfdu!Hfofsbm!Bhhsfhbuf!Mjnju! !2/!B!tfqbsbuf!Eftjhobufe!Dpotusvdujpo!Qspkfdu! gps!boz!puifs!eftjhobufe!dpotusvdujpo!qspkfdu! Hfofsbm!Bhhsfhbuf!Mjnju!bqqmjft!up!fbdi! tipxo!jo!uif!Tdifevmf!bcpwf/! eftjhobufe!dpotusvdujpo!qspkfdu-!boe!uibu!mjnju! jt!frvbm!up!uif!bnpvou!pg!uif!Hfofsbm!!5/!Uif!mjnjut!tipxo!jo!uif!Efdmbsbujpot!gps!Fbdi! Bhhsfhbuf!Mjnju!tipxo!jo!uif!Efdmbsbujpot/!Pddvssfodf-!Ebnbhf!Up!Qsfnjtft!Sfoufe!Up! Zpv!boe!Nfejdbm!Fyqfotf!dpoujovf!up!bqqmz/! !3/!Uif!Eftjhobufe!Dpotusvdujpo!Qspkfdu!Hfofsbm! Ipxfwfs-!jotufbe!pg!cfjoh!tvckfdu!up!uif! Bhhsfhbuf!Mjnju!jt!uif!nptu!xf!xjmm!qbz!gps!uif! Hfofsbm!Bhhsfhbuf!Mjnju!tipxo!jo!uif! tvn!pg!bmm!ebnbhft!voefs!Dpwfsbhf!B-!fydfqu! Efdmbsbujpot-!tvdi!mjnjut!xjmm!cf!tvckfdu!up!uif! ebnbhft!cfdbvtf!pg!#cpejmz!jokvsz#!ps! bqqmjdbcmf!Eftjhobufe!Dpotusvdujpo!Qspkfdu! #qspqfsuz!ebnbhf#!jodmvefe!jo!uif!#qspevdut. Hfofsbm!Bhhsfhbuf!Mjnju/! dpnqmfufe!pqfsbujpot!ib{bse#-!boe!gps! nfejdbm!fyqfotft!voefs!Dpwfsbhf!D! sfhbsemftt!pg!uif!ovncfs!pg;! !b/!Jotvsfet<! !c/!Dmbjnt!nbef!ps!#tvjut#!cspvhiu<!ps! !d/!Qfstpot!ps!pshboj{bujpot!nbljoh!dmbjnt!ps! csjohjoh!#tvjut#/! DH!36!14!16!1:!!Jotvsbodf!Tfswjdft!Pggjdf-!Jod/-!3119!!Qbhf!2!pg!3!! ! C/!Gps!bmm!tvnt!xijdi!uif!jotvsfe!cfdpnft!mfhbmmz!D/!Xifo!dpwfsbhf!gps!mjbcjmjuz!bsjtjoh!pvu!pg!uif! pcmjhbufe!up!qbz!bt!ebnbhft!dbvtfe!cz!#qspevdut.dpnqmfufe!pqfsbujpot!ib{bse#!jt! #pddvssfodft#!voefs!Tfdujpo!J!....!Dpwfsbhf!B-!boe!qspwjefe-!boz!qbznfout!gps!ebnbhft!cfdbvtf!pg! gps!bmm!nfejdbm!fyqfotft!dbvtfe!cz!bddjefout!#cpejmz!jokvsz#!ps!#qspqfsuz!ebnbhf#!jodmvefe!jo! voefs!Tfdujpo!J!....!Dpwfsbhf!D-!xijdi!dboopu!cf!uif!#qspevdut.dpnqmfufe!pqfsbujpot!ib{bse#!xjmm! buusjcvufe!pomz!up!pohpjoh!pqfsbujpot!bu!b!tjohmf!sfevdf!uif!Qspevdut.dpnqmfufe!Pqfsbujpot! eftjhobufe!dpotusvdujpo!qspkfdu!tipxo!jo!uif!Bhhsfhbuf!Mjnju-!boe!opu!sfevdf!uif!Hfofsbm! Tdifevmf!bcpwf;!Bhhsfhbuf!Mjnju!ops!uif!Eftjhobufe!Dpotusvdujpo! Qspkfdu!Hfofsbm!Bhhsfhbuf!Mjnju/! !2/!Boz!qbznfout!nbef!voefs!Dpwfsbhf!B!gps! ebnbhft!ps!voefs!Dpwfsbhf!D!gps!nfejdbm!E/!Jg!uif!bqqmjdbcmf!eftjhobufe!dpotusvdujpo!qspkfdu! fyqfotft!tibmm!sfevdf!uif!bnpvou!bwbjmbcmf!ibt!cffo!bcboepofe-!efmbzfe-!ps!bcboepofe! voefs!uif!Hfofsbm!Bhhsfhbuf!Mjnju!ps!uif!boe!uifo!sftubsufe-!ps!jg!uif!bvuipsj{fe! Qspevdut.dpnqmfufe!Pqfsbujpot!Bhhsfhbuf!dpousbdujoh!qbsujft!efwjbuf!gspn!qmbot-!cmvfqsjout-! Mjnju-!xijdifwfs!jt!bqqmjdbcmf<!boe!eftjhot-!tqfdjgjdbujpot!ps!ujnfubcmft-!uif!qspkfdu! xjmm!tujmm!cf!effnfe!up!cf!uif!tbnf!dpotusvdujpo! !3/!Tvdi!qbznfout!tibmm!opu!sfevdf!boz! qspkfdu/! Eftjhobufe!Dpotusvdujpo!Qspkfdu!Hfofsbm! Bhhsfhbuf!Mjnju/!F/!Uif!qspwjtjpot!pg!Tfdujpo!JJJ!....!Mjnjut!Pg! Jotvsbodf!opu!puifsxjtf!npejgjfe!cz!uijt! foepstfnfou!tibmm!dpoujovf!up!bqqmz!bt! tujqvmbufe/! QPMJDZ!OVNCFS;!DPNNFSDJBM!HFOFSBM!MJBCJMJUZ! !DH!36!15!16!1:! ! UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/!!QMFBTF!SFBE!JU!DBSFGVMMZ/! EFTJHOBUFE!MPDBUJPO)T*!! HFOFSBM!BHHSFHBUF!MJNJU! ! Uijt!foepstfnfou!npejgjft!jotvsbodf!qspwjefe!voefs!uif!gpmmpxjoh;! ! DPNNFSDJBM!HFOFSBM!MJBCJMJUZ!DPWFSBHF!QBSU! TDIFEVMF! Eftjhobufe!Mpdbujpo)t*;! FBDI!MPDBUJPO-!PUIFS!UIBO!DPOTUSVDUJPO!QSPKFDUT-!PDDVQJFE!CZ!UIF!!!!!! OBNFE!JOTVSFE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Jogpsnbujpo!sfrvjsfe!up!dpnqmfuf!uijt!Tdifevmf-!jg!opu!tipxo!bcpwf-!xjmm!cf!tipxo!jo!uif!Efdmbsbujpot/! ! B/!Gps!bmm!tvnt!xijdi!uif!jotvsfe!cfdpnft!mfhbmmz!!c/!Dmbjnt!nbef!ps!#tvjut#!cspvhiu<!ps! pcmjhbufe!up!qbz!bt!ebnbhft!dbvtfe!cz! !d/!Qfstpot!ps!pshboj{bujpot!nbljoh!dmbjnt!ps! #pddvssfodft#!voefs!Tfdujpo!J!....!Dpwfsbhf!B-!boe! csjohjoh!#tvjut#/! gps!bmm!nfejdbm!fyqfotft!dbvtfe!cz!bddjefout! !4/!Boz!qbznfout!nbef!voefs!Dpwfsbhf!B!gps! voefs!Tfdujpo!J!....!Dpwfsbhf!D-!xijdi!dbo!cf! ebnbhft!ps!voefs!Dpwfsbhf!D!gps!nfejdbm! buusjcvufe!pomz!up!pqfsbujpot!bu!b!tjohmf! fyqfotft!tibmm!sfevdf!uif!Eftjhobufe! eftjhobufe!#mpdbujpo#!tipxo!jo!uif!Tdifevmf! Mpdbujpo!Hfofsbm!Bhhsfhbuf!Mjnju!gps!uibu! bcpwf;! eftjhobufe!#mpdbujpo#/!Tvdi!qbznfout!tibmm! !2/!B!tfqbsbuf!Eftjhobufe!Mpdbujpo!Hfofsbm! opu!sfevdf!uif!Hfofsbm!Bhhsfhbuf!Mjnju! Bhhsfhbuf!Mjnju!bqqmjft!up!fbdi!eftjhobufe! tipxo!jo!uif!Efdmbsbujpot!ops!tibmm!uifz! #mpdbujpo#-!boe!uibu!mjnju!jt!frvbm!up!uif!bnpvou! sfevdf!boz!puifs!Eftjhobufe!Mpdbujpo! pg!uif!Hfofsbm!Bhhsfhbuf!Mjnju!tipxo!jo!uif! Hfofsbm!Bhhsfhbuf!Mjnju!gps!boz!puifs! Efdmbsbujpot/! eftjhobufe!#mpdbujpo#!tipxo!jo!uif!Tdifevmf! !3/!Uif!Eftjhobufe!Mpdbujpo!Hfofsbm!Bhhsfhbuf!bcpwf/! Mjnju!jt!uif!nptu!xf!xjmm!qbz!gps!uif!tvn!pg!bmm! !5/!Uif!mjnjut!tipxo!jo!uif!Efdmbsbujpot!gps!Fbdi! ebnbhft!voefs!Dpwfsbhf!B-!fydfqu!ebnbhft! Pddvssfodf-!Ebnbhf!Up!Qsfnjtft!Sfoufe!Up! cfdbvtf!pg!#cpejmz!jokvsz#!ps!#qspqfsuz! Zpv!boe!Nfejdbm!Fyqfotf!dpoujovf!up!bqqmz/! ebnbhf#!jodmvefe!jo!uif!#qspevdut.dpnqmfufe! Ipxfwfs-!jotufbe!pg!cfjoh!tvckfdu!up!uif! pqfsbujpot!ib{bse#-!boe!gps!nfejdbm!fyqfotft! Hfofsbm!Bhhsfhbuf!Mjnju!tipxo!jo!uif! voefs!Dpwfsbhf!D!sfhbsemftt!pg!uif!ovncfs! Efdmbsbujpot-!tvdi!mjnjut!xjmm!cf!tvckfdu!up!uif! pg;! bqqmjdbcmf!Eftjhobufe!Mpdbujpo!Hfofsbm! !b/!Jotvsfet<!Bhhsfhbuf!Mjnju/! DH!36!15!16!1:!!Jotvsbodf!Tfswjdft!Pggjdf-!Jod/-!3119!!Qbhf!2!pg!3!! ! C/!Gps!bmm!tvnt!xijdi!uif!jotvsfe!cfdpnft!mfhbmmz!D/!Xifo!dpwfsbhf!gps!mjbcjmjuz!bsjtjoh!pvu!pg!uif! pcmjhbufe!up!qbz!bt!ebnbhft!dbvtfe!cz!#qspevdut.dpnqmfufe!pqfsbujpot!ib{bse#!jt! #pddvssfodft#!voefs!Tfdujpo!J!....!Dpwfsbhf!B-!boe!qspwjefe-!boz!qbznfout!gps!ebnbhft!cfdbvtf!pg! gps!bmm!nfejdbm!fyqfotft!dbvtfe!cz!bddjefout!#cpejmz!jokvsz#!ps!#qspqfsuz!ebnbhf#!jodmvefe!jo! voefs!Tfdujpo!J!....!Dpwfsbhf!D-!xijdi!dboopu!cf!uif!#qspevdut.dpnqmfufe!pqfsbujpot!ib{bse#!xjmm! buusjcvufe!pomz!up!pqfsbujpot!bu!b!tjohmf!sfevdf!uif!Qspevdut.dpnqmfufe!Pqfsbujpot! eftjhobufe!#mpdbujpo#!tipxo!jo!uif!Tdifevmf!Bhhsfhbuf!Mjnju-!boe!opu!sfevdf!uif!Hfofsbm! bcpwf;!Bhhsfhbuf!Mjnju!ops!uif!Eftjhobufe!Mpdbujpo! Hfofsbm!Bhhsfhbuf!Mjnju/! !2/!Boz!qbznfout!nbef!voefs!Dpwfsbhf!B!gps! ebnbhft!ps!voefs!Dpwfsbhf!D!gps!nfejdbm!E/!Gps!uif!qvsqptft!pg!uijt!foepstfnfou-!uif! fyqfotft!tibmm!sfevdf!uif!bnpvou!bwbjmbcmf!Efgjojujpot!Tfdujpo!jt!bnfoefe!cz!uif!beejujpo!pg! voefs!uif!Hfofsbm!Bhhsfhbuf!Mjnju!ps!uif!uif!gpmmpxjoh!efgjojujpo;!! Qspevdut.dpnqmfufe!Pqfsbujpot!Bhhsfhbuf! #Mpdbujpo#!nfbot!qsfnjtft!jowpmwjoh!uif!tbnf!ps! Mjnju-!xijdifwfs!jt!bqqmjdbcmf<!boe! dpoofdujoh!mput-!ps!qsfnjtft!xiptf!dpoofdujpo!jt! !3/!Tvdi!qbznfout!tibmm!opu!sfevdf!boz!joufssvqufe!pomz!cz!b!tusffu-!spbexbz-!xbufsxbz! Eftjhobufe!Mpdbujpo!Hfofsbm!Bhhsfhbuf!Mjnju/!ps!sjhiu.pg.xbz!pg!b!sbjmspbe/! F/!Uif!qspwjtjpot!pg!Tfdujpo!JJJ!....!Mjnjut!Pg! Jotvsbodf!opu!puifsxjtf!npejgjfe!cz!uijt! foepstfnfou!tibmm!dpoujovf!up!bqqmz!bt! tujqvmbufe/! Other Insurance Amendment – Primary And Non- Contributory Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l. PremReturn Prem. GLO 1817406-010/01/2010/01/2010/01/2075272000N/AN/A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1.The following paragraph is added to the Other Insurance Condition of Section IV – Commercial General Liability Conditions: This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policyprovided that: a.The additional insured is a Named Insured under suchother insurance; and b.You are required by awrittencontract or written agreement that this insurance would be primaryand wouldnot seek contribution from anyother insuranceavailable to the additional insured. 2.The following paragraph is added to Paragraph 4.b.of the Other Insurance Condition of Section IV – Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense,claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions of this policy remain unchanged. U-GL-1327-BCW (04/13) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. QPMJDZ!OVNCFS;DPNNFSDJBM!HFOFSBM!MJBCJMJUZ DH!35!28!21!12 UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/!!QMFBTF!SFBE!JU!DBSFGVMMZ/ DPOUSBDUVBM!MJBCJMJUZ!.!SBJMSPBET Uijt!foepstfnfou!npejgjft!jotvsbodf!qspwjefe!voefs!uif!gpmmpxjoh; DPNNFSDJBM!HFOFSBM!MJBCJMJUZ!DPWFSBHF!QBSU TDIFEVMF !Tdifevmfe!Sbjmspbe;!Eftjhobufe!Kpc!Tjuf; BMM!DPOUSBDUT!GPS!XPSL!EPOF!GPS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! SBJMSPBET-!BT!SFRVJSFE!CZ!XSJUUFO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! DPOUSBDU!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !)Jg!op!fousz!bqqfbst!bcpwf-!jogpsnbujpo!sfrvjsfe!up!dpnqmfuf!uijt!foepstfnfou!xjmm!cf!tipxo!jo!uif!Efdmbsbujpot bt!bqqmjdbcmf!up!uijt!foepstfnfou/* Xjui!sftqfdu!up!pqfsbujpot!qfsgpsnfe!gps-!ps!bggfdujoh-Qbsbhsbqi!g/!epft!opu!jodmvef!uibu!qbsu!pg!boz b!Tdifevmfe!Sbjmspbe!bu!b!Eftjhobufe!Kpc!Tjuf-!uifdpousbdu!ps!bhsffnfou; efgjojujpo!pg!#jotvsfe!dpousbdu#!jo!uif!Efgjojujpot!tfd. )2*Uibu!joefnojgjft!bo!bsdijufdu-!fohjoffs!ps ujpo!jt!sfqmbdfe!cz!uif!gpmmpxjoh; tvswfzps!gps!jokvsz!ps!ebnbhf!bsjtjoh!pvu :/#Jotvsfe!Dpousbdu#!nfbot;pg; b/B!dpousbdu!gps!b!mfbtf!pg!qsfnjtft/!Ipxfwfs-)b*Qsfqbsjoh-!bqqspwjoh!ps!gbjmjoh!up!qsf. uibu!qpsujpo!pg!uif!dpousbdu!gps!b!mfbtf!pgqbsf!ps!bqqspwf!nbqt-!tipq!esbxjoht- qsfnjtft!uibu!joefnojgjft!boz!qfstpo!ps!ps.pqjojpot-!sfqpsut-!tvswfzt-!gjfme!psefst- hboj{bujpo!gps!ebnbhf!cz!gjsf!up!qsfnjtft!xijmfdibohf!psefst!ps!esbxjoht!boe!tqfdjgj. sfoufe!up!zpv!ps!ufnqpsbsjmz!pddvqjfe!cz!zpvdbujpot<!ps xjui!qfsnjttjpo!pg!uif!pxofs!jt!opu!bo!#jotvsfe )c*Hjwjoh!ejsfdujpot!ps!jotusvdujpot-!ps dpousbdu#< gbjmjoh!up!hjwf!uifn-!jg!uibu!jt!uif!qsjnbsz c/B!tjefusbdl!bhsffnfou<dbvtf!pg!uif!jokvsz!ps!ebnbhf< d/Boz!fbtfnfou!ps!mjdfotf!bhsffnfou<)3*Voefs!xijdi!uif!jotvsfe-!jg!bo!bsdijufdu- fohjoffs!ps!tvswfzps-!bttvnft!mjbcjmjuz!gps e/Bo!pcmjhbujpo-!bt!sfrvjsfe!cz!psejobodf-!up bo!jokvsz!ps!ebnbhf!bsjtjoh!pvu!pg!uif!jo. joefnojgz!b!nvojdjqbmjuz-!fydfqu!jo!dpoofdujpo tvsfe‘t!sfoefsjoh!ps!gbjmvsf!up!sfoefs!qsp. xjui!xpsl!gps!b!nvojdjqbmjuz< gfttjpobm!tfswjdft-!jodmvejoh!uiptf!mjtufe!jo f/Bo!fmfwbups!nbjoufobodf!bhsffnfou< Qbsbhsbqi!)2*!bcpwf!boe!tvqfswjtpsz-!jo. tqfdujpo-!bsdijufduvsbm!ps!fohjoffsjoh!bdujwj. g/Uibu!qbsu!pg!boz!puifs!dpousbdu!ps!bhsffnfou ujft/ qfsubjojoh!up!zpvs!cvtjoftt!)jodmvejoh!bo!jo. efnojgjdbujpo!pg!b!nvojdjqbmjuz!jo!dpoofdujpo xjui!xpsl!qfsgpsnfe!gps!b!nvojdjqbmjuz*!voefs xijdi!zpv!bttvnf!uif!upsu!mjbcjmjuz!pg!bopuifs qbsuz!up!qbz!gps!#cpejmz!jokvsz#!ps!#qspqfsuz ebnbhf#!up!b!uijse!qfstpo!ps!pshboj{bujpo/!Upsu mjbcjmjuz!nfbot!b!mjbcjmjuz!uibu!xpvme!cf!jnqptfe cz!mbx!jo!uif!bctfodf!pg!boz!dpousbdu!ps bhsffnfou/ DH!35!28!21!12!JTP!Qspqfsujft-!Jod/-!!3111!Qbhf!2!pg!2 POLICYNUMBER:BAP1857085-0 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are insureds for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is only to the extent that person or organization qualifies contained in ParagraphA.1. of Section IICovered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms andParagraph D.2.of SectionICovered Autos Coveragesof the Auto Dealers Coverage Form. CA 20 48 1013© Insurance Services Office, Inc.,2011Page 1 of 1 GLO1817406-010/01/2010/01/2075272000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver notification that such Coverage Part has been cancelled or non-renewed to each person or organization shown in a list provided to us by the first Named Insured if you are required by written contact or written agreement to provide such notification. However, such notification will not be mailed or delivered if a conditional notice of renewal has been sent to the first Named Insured. Such list: 1.Must be provided to us prior to cancellation or non-renewal; 2.Must contain the names and addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled or non-renewed; and 3.Must be in an electronic format that is acceptable to us. B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records as of the date the notice of cancellation or non-renewal is mailed or delivered to the first Named Insured. We will mail or deliver such notification to each person or organization shown in the list: 1.Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or 2.At least 30 days prior to the effective date of: a.Cancellation, if cancelled for any reason other than nonpayment of premium; or b.Non-renewal, but not including conditional notice of renewal. C. Our mailing or delivery of notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such mailing or delivery will not: 1.Extend the Coverage Part cancellation or non-renewal date; 2.Negate the cancellation or non-renewal; or 3.Provide any additional insurance that would not have been provided in the absence of this endorsement. D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided to us as described in Paragraphs A. and B. of this endorsement. All other terms and conditions of this policy remain unchanged. U-GL-1521-A CW (10/12) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Cmbolfu!Opujgjdbujpo!up!Puifst!pg!Dbodfmmbujpo! ps!Opo.Sfofxbm! Qpmjdz!!Op/!Fgg/!!Ebuf!!pg!!Qpm/!Fyq/!!Ebuf!!pg!!Qpm/!Fgg/!Ebuf!pg!Foe/!Qspevdfs!Op/!Bee(m/!Qsfn!Sfuvso!Qsfn/! ! ! UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/!!QMFBTF!SFBE!JU!DBSFGVMMZ/! Uijt!foepstfnfou!npejgjft!jotvsbodf!qspwjefe!voefs!uif;! Dpnnfsdjbm!Bvupnpcjmf!Dpwfsbhf!Qbsu! B/!Jg!xf!dbodfm!ps!opo.sfofx!uijt!Dpwfsbhf!Qbsu!cz!xsjuufo!opujdf!up!uif!gjstu!Obnfe!Jotvsfe-!xf!xjmm!nbjm!ps!efmjwfs! opujgjdbujpo!uibu!tvdi!Dpwfsbhf!Qbsu!ibt!cffo!dbodfmmfe!ps!opo.sfofxfe!up!fbdi!qfstpo!ps!pshboj{bujpo!tipxo!jo!b! mjtu!qspwjefe!up!vt!cz!uif!gjstu!Obnfe!Jotvsfe!jg!zpv!bsf!sfrvjsfe!cz!xsjuufo!dpoubdu!ps!xsjuufo!bhsffnfou!up!qspwjef! tvdi!opujgjdbujpo/!!Ipxfwfs-!tvdi!opujgjdbujpo!xjmm!opu!cf!nbjmfe!ps!efmjwfsfe!jg!b!dpoejujpobm!opujdf!pg!sfofxbm!ibt!cffo! tfou!up!uif!gjstu!Obnfe!Jotvsfe/!!Tvdi!mjtu;! 2/!Nvtu!cf!qspwjefe!up!vt!qsjps!up!dbodfmmbujpo!ps!opo.sfofxbm<! 3/!Nvtu!dpoubjo!uif!obnft!boe!beesfttft!pg!pomz!uif!qfstpot!ps!pshboj{bujpot!sfrvjsjoh!opujgjdbujpo!uibu!tvdi! Dpwfsbhf!Qbsu!ibt!cffo!dbodfmmfe!ps!opo.sfofxfe<!boe! 4/!Nvtu!cf!jo!bo!fmfduspojd!gpsnbu!uibu!jt!bddfqubcmf!up!vt/! C/!Pvs!opujgjdbujpo!bt!eftdsjcfe!jo!Qbsbhsbqi!B/!pg!uijt!foepstfnfou!xjmm!cf!cbtfe!po!uif!nptu!sfdfou!mjtu!jo!pvs!sfdpset! bt!pg!uif!ebuf!uif!opujdf!pg!dbodfmmbujpo!ps!opo.sfofxbm!jt!nbjmfe!ps!efmjwfsfe!up!uif!gjstu!Obnfe!Jotvsfe/!!Xf!xjmm!nbjm! ps!efmjwfs!tvdi!opujgjdbujpo!up!fbdi!qfstpo!ps!pshboj{bujpo!tipxo!jo!uif!mjtu;! 2/!Xjuijo!tfwfo!ebzt!pg!uif!fggfdujwf!ebuf!pg!uif!opujdf!pg!dbodfmmbujpo-!jg!xf!dbodfm!gps!opo.qbznfou!pg!qsfnjvn<!ps 3/!Bu!mfbtu!41!ebzt!qsjps!up!uif!fggfdujwf!ebuf!pg;! b/!Dbodfmmbujpo-!jg!dbodfmmfe!gps!boz!sfbtpo!puifs!uibo!opoqbznfou!pg!qsfnjvn<!ps! c/!Opo.sfofxbm-!cvu!opu!jodmvejoh!dpoejujpobm!opujdf!pg!sfofxbm/! D/!Pvs!nbjmjoh!ps!efmjwfsz!pg!opujgjdbujpo!eftdsjcfe!jo!Qbsbhsbqit!B/!boe!C/!pg!uijt!foepstfnfou!jt!joufoefe!bt!b!dpvsuftz! pomz/!!Pvs!gbjmvsf!up!qspwjef!tvdi!nbjmjoh!ps!efmjwfsz!xjmm!opu;! 2/!Fyufoe!uif!Dpwfsbhf!Qbsu!dbodfmmbujpo!ps!opo.sfofxbm!ebuf<! 3/!Ofhbuf!uif!dbodfmmbujpo!ps!opo.sfofxbm<!ps! 4/!Qspwjef!boz!beejujpobm!jotvsbodf!uibu!xpvme!opu!ibwf!cffo!qspwjefe!jo!uif!bctfodf!pg!uijt!foepstfnfou/! E/!Xf!bsf!opu!sftqpotjcmf!gps!uif!bddvsbdz-!joufhsjuz-!ujnfmjoftt!boe!wbmjejuz!pg!jogpsnbujpo!dpoubjofe!jo!uif!mjtu!qspwjefe! up!vt!bt!eftdsjcfe!jo!Qbsbhsbqit!B/!boe!C/!pg!uijt!foepstfnfou/! Bmm!puifs!ufsnt!boe!dpoejujpot!pg!uijt!qpmjdz!sfnbjo!vodibohfe/! V.DB.943.B!DX!)12024*! Qbhf!2!pg!2! Jodmveft!dpqzsjhiufe!nbufsjbm!pg!Jotvsbodf!Tfswjdft!Pggjdf-!Jod/-!xjui!jut!qfsnjttjpo/! WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION WC 00 03 13 (Ed. 4-84) 1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 42 03 04 B (Ed. 6-14) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1.()Specific Waiver Name of person or organization ()Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2.Operations: ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION. 3.Premium: The premium charge for this endorsement shall be percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Advance Premium: WC 42 03 04 B (Ed. 6-14) © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. XPSLFST!DPNQFOTBUJPO!BOE!FNQMPZFST!MJBCJMJUZ!JOTVSBODF!QPMJDZ!XD!54!14!16! )Fe/!8.11*! VUBI!XBJWFS!PG!TVCSPHBUJPO!FOEPSTFNFOU! Uijt!foepstfnfou!bqqmjft!pomz!up!uif!jotvsbodf!qspwjefe!cz!uif!qpmjdz!cfdbvtf!Vubi!jt!tipxo!jo!Jufn!4/B/!pg!uif! Jogpsnbujpo!Qbhf/! Xf!ibwf!uif!sjhiu!up!sfdpwfs!pvs!qbznfout!gspn!bozpof!mjbcmf!gps!bo!jokvsz!dpwfsfe!cz!uijt!qpmjdz/!Xf!xjmm!opu!fogpsdf! pvs!sjhiu!bhbjotu!uif!qfstpo!ps!pshboj{bujpo!obnfe!jo!uif!Tdifevmf/!)Uijt!bhsffnfou!bqqmjft!pomz!up!uif!fyufou!uibu! zpv!qfsgpsn!xpsl!voefs!b!xsjuufo!dpousbdu!uibu!sfrvjsft!zpv!up!pcubjo!uijt!bhsffnfou!gspn!vt/*! Uijt!bhsffnfou!tibmm!opu!pqfsbuf!ejsfdumz!ps!joejsfdumz!up!cfofgju!bozpof!opu!obnfe!jo!uif!Tdifevmf/!Pvs!xbjwfs!pg! sjhiut!epft!opu!sfmfbtf!zpvs!fnqmpzfft‘!sjhiut!bhbjotu!uijse!qbsujft!boe!epft!opu!sfmfbtf!pvs!bvuipsjuz!bt!usvtuff!pg! dmbjnt!bhbjotu!uijse!qbsujft/! Tdifevmf! BMM!QFSTPOT!BOE0PS!PSHBOJ\[BUJPOT!UIBU!BSF!SFRVJSFE!CZ XSJUUFO!DPOUSBDU!PS!BHSFFNFOU!XJUI!UIF!JOTVSFE-!FYFDVUFE!!!! QSJPS!UP!UIF!BDDJEFOU!PS!MPTT-!UIBU!XBJWFS!PG!TVCSPHBUJPO!!! CF!QSPWJEFE!VOEFS!UIJT!QPMJDZ!GPS!XPSL!QFSGPSNFE!CZ!ZPV!GPS! UIBU!QFSTPO!BOE0PS!PSHBOJ\[BUJPO/ XD!54!14!16! )Fe/!8.11*!! !3111!Obujpobm!Dpvodjm!po!Dpnqfotbujpo!Jotvsbodf-!Jod/! XPSLFST!DPNQFOTBUJPO!BOE!FNQMPZFST!MJBCJMJUZ!JOTVSBODF!QPMJDZ!XD!::!17!54! CMBOLFU!OPUJGJDBUJPO!UP!PUIFST!PG!DBODFMMBUJPO!PS!OPOSFOFXBM!FOEPSTFNFOU! Uijt!foepstfnfou!beet!uif!gpmmpxjoh!up!Qbsu!Tjy!pg!uif!qpmjdz/! QBSU!TJY! DPOEJUJPOT! Cmbolfu!Opujgjdbujpo!up!Puifst!pg!Dbodfmmbujpo!ps!Oposfofxbm! 2/Jg!xf!dbodfm!ps!opo.sfofx!uijt!qpmjdz!cz!xsjuufo!opujdf!up!zpv-!xf!xjmm!nbjm!ps!efmjwfs!opujgjdbujpo!uibu!tvdi qpmjdz!ibt!cffo!dbodfmmfe!ps!opo.sfofxfe!up!fbdi!qfstpo!ps!pshboj{bujpo!tipxo!jo!b!mjtu!qspwjefe!up!vt!cz zpv!jg!zpv!bsf!sfrvjsfe!cz!xsjuufo!dpousbdu!ps!xsjuufo!bhsffnfou!up!qspwjef!tvdi!opujgjdbujpo/!!Ipxfwfs-!tvdi opujgjdbujpo!xjmm!opu!cf!nbjmfe!ps!efmjwfsfe!jg!b!dpoejujpobm!opujdf!pg!sfofxbm!ibt!cffo!tfou!up!zpv/!!Tvdi!mjtu; b/Nvtu!cf!qspwjefe!up!vt!qsjps!up!dbodfmmbujpo!ps!opo.sfofxbm< c/Nvtu!dpoubjo!uif!obnft!boe!beesfttft!pg!pomz!uif!qfstpot!ps!pshboj{bujpot!sfrvjsjoh!opujgjdbujpo!uibu tvdi!qpmjdz!ibt!cffo!dbodfmmfe!ps!opo.sfofxfe<!boe d/Nvtu!cf!jo!bo!fmfduspojd!gpsnbu!uibu!jt!bddfqubcmf!up!vt/ 3/Pvs!opujgjdbujpo!bt!eftdsjcfe!jo!Qbsbhsbqi!2/!bcpwf!xjmm!cf!cbtfe!po!uif!nptu!sfdfou!mjtu!jo!pvs!sfdpset!bt!pg uif!ebuf!uif!opujdf!pg!dbodfmmbujpo!ps!opo.sfofxbm!jt!nbjmfe!ps!efmjwfsfe!up!zpv/!!Xf!xjmm!nbjm!ps!efmjwfs!tvdi opujgjdbujpo!up!fbdi!qfstpo!ps!pshboj{bujpo!tipxo!jo!uif!mjtu; b/Xjuijo!tfwfo!ebzt!pg!uif!fggfdujwf!ebuf!pg!uif!opujdf!pg!dbodfmmbujpo-!jg!xf!dbodfm!gps!opo.qbznfou!pg qsfnjvn<!ps c/Bu!mfbtu!41!ebzt!qsjps!up!uif!fggfdujwf!ebuf!pg; )2*!Dbodfmmbujpo-!jg!dbodfmmfe!gps!boz!sfbtpo!puifs!uibo!opoqbznfou!pg!qsfnjvn<!ps )3*!Opo.sfofxbm-!cvu!opu!jodmvejoh!dpoejujpobm!opujdf!pg!sfofxbm/ 4/Pvs!nbjmjoh!ps!efmjwfsz!pg!opujgjdbujpo!eftdsjcfe!jo!Qbsbhsbqit!2/!boe!3/!bcpwf!jt!joufoefe!bt!b!dpvsuftz!pomz/ Pvs!gbjmvsf!up!qspwjef!tvdi!nbjmjoh!ps!efmjwfsz!xjmm!opu; b/Fyufoe!uif!qpmjdz!dbodfmmbujpo!ps!opo.sfofxbm!ebuf< c/Ofhbuf!uif!dbodfmmbujpo!ps!opo.sfofxbm<!ps d/Qspwjef!boz!beejujpobm!jotvsbodf!uibu!xpvme!opu!ibwf!cffo!qspwjefe!jo!uif!bctfodf!pg!uijt!foepstfnfou/ 5/Xf!bsf!opu!sftqpotjcmf!gps!uif!bddvsbdz-!joufhsjuz-!ujnfmjoftt!boe!wbmjejuz!pg!jogpsnbujpo!dpoubjofe!jo!uif!mjtu qspwjefe!up!vt!bt!eftdsjcfe!jo!Qbsbhsbqit!2/!boe!3/!bcpwf/ Bmm!puifs!ufsnt!boe!dpoejujpot!pg!uijt!qpmjdz!sfnbjo!vodibohfe/! Uijt!foepstfnfou!dibohft!uif!qpmjdz!up!xijdi!ju!jt!buubdife!boe!jt!fggfdujwf!po!uif!ebuf!jttvfe!vomftt!puifsxjtf!tubufe/! )Uif!jogpsnbujpo!cfmpx!jt!sfrvjsfe!pomz!xifo!uijt!foepstfnfou!jt!jttvfe!tvctfrvfou!up!qsfqbsbujpo!pg!uif!qpmjdz/*! Foepstfnfou!Fggfdujwf!Qpmjdz!Op/!Foepstfnfou!Op/! Jotvsfe!Qsfnjvn!%! Jotvsbodf!Dpnqboz! XD!::!17!54!Qbhf!2!pg!2! )Fe/!12.24*!Jodmveft!dpqzsjhiu!nbufsjbm!pg!uif!Obujpobm!Dpvodjm!po!Dpnqfotbujpo!Jotvsbodf-!Jod/!vtfe!xjui!jut!qfsnjttjpo/! !3123!Dpqzsjhiu!Obujpobm!Dpvodjm!po!Dpnqfotbujpo!Jotvsbodf-!Jod/!Bmm!Sjhiut!Sftfswfe/! QPMJDZ!OVNCFS;!DPNNFSDJBM!HFOFSBM!MJBCJMJUZ! !DH!35!15!16!1:! ! XBJWFS!PG!USBOTGFS!PG!SJHIUT!PG!SFDPWFSZ!! BHBJOTU!PUIFST!UP!VT! ! Uijt!foepstfnfou!npejgjft!jotvsbodf!qspwjefe!voefs!uif!gpmmpxjoh;!! ! DPNNFSDJBM!HFOFSBM!MJBCJMJUZ!DPWFSBHF!QBSU! QSPEVDUT0DPNQMFUFE!PQFSBUJPOT!MJBCJMJUZ!DPWFSBHF!QBSU! ! TDIFEVMF! ! Obnf!Pg!Qfstpo!Ps!Pshboj{bujpo;!! BOZ!QFSTPO!PS!PSHBOJ\[BUJPO!UIBU!SFRVJSFT!ZPV!UP!XBJWF!ZPVS!SJHIUT!PG!! SFDPWFSZ-!JO!B!XSJUUFO!DPOUSBDU!PS!BHSFFNFOU!XJUI!UIF!OBNFE!JOTVSFE!!! UIBU!JT!FYFDVUFE!QSJPS!UP!UIF!BDDJEFOU!PS!MPTT/!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Jogpsnbujpo!sfrvjsfe!up!dpnqmfuf!uijt!Tdifevmf-!jg!opu!tipxo!bcpwf-!xjmm!cf!tipxo!jo!uif!Efdmbsbujpot/! ! Uif!gpmmpxjoh!jt!beefe!up!Qbsbhsbqi!9/!Usbotgfs!Pg! Sjhiut!Pg!Sfdpwfsz!Bhbjotu!Puifst!Up!Vt!pg!Tfdujpo! JW!....!Dpoejujpot;! Xf!xbjwf!boz!sjhiu!pg!sfdpwfsz!xf!nbz!ibwf!bhbjotu! uif!qfstpo!ps!pshboj{bujpo!tipxo!jo!uif!Tdifevmf! bcpwf!cfdbvtf!pg!qbznfout!xf!nblf!gps!jokvsz!ps! ebnbhf!bsjtjoh!pvu!pg!zpvs!pohpjoh!pqfsbujpot!ps! #zpvs!xpsl#!epof!voefs!b!dpousbdu!xjui!uibu!qfstpo! ps!pshboj{bujpo!boe!jodmvefe!jo!uif!#qspevdut. dpnqmfufe!pqfsbujpot!ib{bse#/!Uijt!xbjwfs!bqqmjft! pomz!up!uif!qfstpo!ps!pshboj{bujpo!tipxo!jo!uif! Tdifevmf!bcpwf/!! DH!35!15!16!1:!!Jotvsbodf!Tfswjdft!Pggjdf-!Jod/-!3119!!Qbhf!2!pg!2!! ! NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Tetra Tech, Inc. Name: Project A-2021-035-01 Number: Project First Amendment To Agreement To Provide On-Call Water Name: Resources Engineering Services (Tetra Tech) The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: EXPIRATION TYPE OF INSURANCE POLICY NUMBER COI DATE FILE NAME DATE City of Santa Ana- AUTOMOBILE LIABILITY BAP185708504 10/01/2023 09/27/2022 570095585268.pdf City of Santa Ana- ENV CONTR PROF 03120276 10/01/2023 09/27/2022 570095585268.pdf City of Santa Ana- GENERAL LIABILITY GLO181740604 10/01/2023 09/27/2022 570095585268.pdf WORKERS COMPENSATION AND EMPLOYERS' City of Santa Ana- WC185708704 10/01/2023 09/27/2022 LIABILITY 570095585268.pdf WORKERS COMPENSATION AND EMPLOYERS' City of Santa Ana- WC254061604 10/01/2023 09/27/2022 LIABILITY 570095585268.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 10/13/2022 12:30 PM