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HomeMy WebLinkAboutTETRA TECH, INC. (5)INSURANCE ON FILE WORT( MAY PROCEED UNTIL INSURANCE EXPIRES MAYOR CLERIC OF COUNCIL Vicente Sarmiejol MAYOR PRO TEM' David Penaloza COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez Nelida Mendoza Thai Yet Phan CITY OF SANTA ANA PUBLIC WORKS AGENCY 1 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 %mw.santa-ana.ora April 19, 2021 Tetra Tech, Inc. 17885 Von Karman Avenue, Suite 500 Irvine, CA 92614 Arm: Mr. Tom Epperson, P.E., Vice President A-2018-160-02A CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Re: Extension of Agreement to Provide On -Call Eneineerin Services for Water Resources Agreement No. A-2018-160-02 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Tetra Tech, Inc., and the City of Santa Ana, dated June 19, 2018, the time period of the Agreement is hereby extended for an additional two-year period, from June 19, 2021 through June 18, 2023. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. �%�Sincerely, d L-`�4 i 143V Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA ATTEST Krist ne Ridge City Manager Daisy Gomez, MMC Clerk of the Council APPROVED AS TO FORM 7 Jo M. Funk Senior Assistant City Attorney ;C�ON�SUTANT Name: om Epper"e% P.E. Title: Utce SANTA ANA CITY COUNCIL V.M. Samaenlo David Panebss Thai Vial Phan Jessie Losez Phil a... JohnaMan Ryan wmandez N.M. Mendoza Mayor MayorPm Tam, WeM] Ward WaM6 WeM4 tmanavm .na nm dAMs nak,Yhsaana de ohanosae"na eWeMB rn iecAGlopeL®adnWna omyhecen3'�ian rvanl,eman, WWaiMdS e n. Francine R. Digitally signed by Francine R. Ylanual Villareal Date: 2020.10.29095646 -0 -DIX CERTIFICATE DAT1007/2202OWYY) OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Insurance Services West, Inc. LOS Angeles CA Office 707 Wilshire Boulevard Suite 2600 CONTACT NAME: PHONE (g66) 283-7122 FAX (BOO) 363-0105 INC. No. Ex4: pIC. No.: E-MAIL ADDRESS: Los Angeles CA 90017-0460 USA INSURER(S) AFFORDING COVERAGE NAIC tt INSURED INSURER A: Lexington Insurance Company 19437 Tetra Tech, Inc. 17885 Von Karman Ave., Suite 500 Irvine CA 92614 USA INSURER e: Zurich American Ins Co 16535 INSURER G American International Group UK Ltd AA1120187 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. Limits shown are as requested LTq TYPE OF INSURANCE INSO WVO POLICY NUMBER MULICYLVV MIDDIV POLICYEXP MM,DI)yYYYd LIMITS B GLO EACHOCCURRENCE $1,000,000 TXCCMWRCIALOE"2RALLIAB[LffY CIAIMS-MADE ❑X OCCUR_ffT RENTED PREMISES EamxED,U $1,000,000 MED EXP(Any one person) $10,000 Coverage PERSONAL &ACV INJURY $1,000,000 GEN•LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X PRO X LOG JECT PRODUCTS - COMPIOP AGG $2,000,000 OTHER: B AUTOMOBILE LIABILITY BAP 1857085 02 10/01/20201010112021 COMBINED SINGLE LIMIT Ea accident $5,000,000 BODILY INJURY (Perperson) X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTCB HIRED AUTOS NONOWNEDPROPERTY ONLY AUTOS ONLY BODILY INJURY (Per accident) DAMAGE Peracodenl C )( UMBRELLALIAB OCCUR 62785232 EACH OCCURRENCE $2,000,000 EXCESS LIAR N CLAIMSMADEAGGREGATE .000, 000 OEDI RETENTION B q WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICERMEMBER EXCLUDED? (Model., in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA WC254061602 WC185709702 10/01/2020 10/01/2020 10/01/2021 10/01/2021 X PER STATUTE OTH- ER EL EACH ACCIDENT $1,000,000 EL.DISEASE-EA EMPLOYEE $1,000,000 E. L. DISEASE -POLICY LIMIT $1,000,000 A Env Contr Prof UZ81NZ375 Prof/Poll Liab 10/01/2019 10/01/2021 Each Clain Aggregate $1,000,000 S2,000,000 SIR applies per policy ter is & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, officers, agents, employees and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability policy as required by written contract. General Liability policy evidenced herein is Primary and Non -Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions as required by written contract. Stop Gap coverage for the following states: OH, NO, WA, WY. CERTIFICATE HOLDER CANCELLATION SHOULD My OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Risk Management Division 20 civic Center Plaza Santa Ana CA 92702 USA 019BB-2015 ACORD COF ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk MmMgemgdDtt' I r(REVIEWED & APPROVED Br I i rMLNHr.[ f1. V�[LX�wL[ �'. ® Risk Management Malys[ AGENCY CUSTOMER ID: 570000036654 i"1 ® LOC #: A� o ADDITIONAL REMARKS SCHEDULE Paoe _ of AGENCY ACT Risk insurance Services west, Inc. NAMED INSURED Tetra Tech, Inc. POLICYNUMBER See Attached certificate CARRIER See Attached certificate NAIC CODE EFFECTIVE DATE: AUIII IIUIVAL MtMAKKb THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate Of Liability Insurance Stop Gap coverage for the following states: Oft, ND, WA, WY. ACORD fill (2008101 ) ® 2008 ACORD CDRPOR/ The ACORD name and logo are registered marks of ACORD Risk Management D rvision REVIEWED&APPROvm BY: a i �'nau.c:-a.l �. V:.QiwucQ Risk Management Analyst Additional Insured — Owners, Lessees Or Contractors — Ongoing Operations — Scheduled ZURICH Policy No. Eff. Dale of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AWL Prem Return Prem. GLO 1817406-02 10/01/2020 10/01/2021 10/01/2020 75272000 N/A N/A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name of Person or Organization: Location and Description of Ongoing Operations: Additional Premium: Any person or organization to whom or to which you are required to provide additional insured status in aor Any location or project, other than awrap-up or other N/A written contract or written agreement executed prior consolidated insurance program location or project to the loss, except where such contract or agreement for which insurance is otherwise separately provided is prohibited by law. to you by a wrap-up or other consolidate insurance program. A. Section II — Who Is An Insured is amended to include as an insured any person or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of your ongoing operations performed for that insured at or from the corresponding 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 any additional insured shown in the Schedule of this endorsement, the following additional exclusion applies: 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. Includes copyrighted material of Insurance Services Office, Inc., with its permission �. Risk Mnagnnnrtoh;sian s REV1E &APPROV®aV: ;= r�4 rM4Mlhf.2 ^. V m"I REW Risk Management Matyrt 0 Additional Insured — Owners, Lessees Or Contractors — ZURICH Completed Operations — Scheduled Policy No. I Eff. Date of Pol. I Exp. Dale of Pol. I Eff. Date of End. Producer No. Add'I. Prem Return Prem. GLO 1817406-02 1 10/01/2020 1 10/01/2021 1 10/01/2020 75272000 N/A N/A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name of Person or Organization: Location and Description of Completed Operations: Additional Premium: Any person or organization to whom or to which you are required provide additional insured status in Any location or project, other than a wrap-up or other N/A written contract written agreement executed priorr consolidated insurance program location or project to the loss, except where such contract or agreement for which insurance is otherwise separately provided is prohibited by law. to you by a wrap-up or other consolidate insurance program. Section II — Who Is An Insured is amended to include as an insured any person 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 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. All other terms and conditions of this policy remain unchanged. .aS'°e yi a 2 RiskMPPRNEMEWERisk Management Malyst Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: GLO 1817406-02 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): A GENERAL AGGREGATE LIMIT APPLIES TO EACH CONSTRUCTION PROJECT WHERE THE NAMED INSURED IS PERFORMING OPERATIONS, HOWEVER, A GENERAL AGGREGATE LIMIT DOES NOT APPLY TO ANY CONSTRUCTION PROJECT WHERE THE NAMED INSURED IS PERFORMING OPERATIONS THAT ARE INSURED UNDER A WRAP UP OR ANY OTHER CONSOLIDATED OR SIMILAR INSURANCE PROGRAM. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I —Coverage A, and for all medical expenses caused by accidents under Section I —Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. CG 25 03 05 09 ® Insurance Services Office, Inc., 2008 REVIEWED TUnAPPR k Mamagzm�t Division r& 1 r�.l1.I z V cunt Risk Management Malyst OF B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occurrences" under Section I —Coverage A, and for all medical expenses caused by accidents under Section I —Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III —Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 Risk Management D Msinn oil 9j REVIEWED& APPR(WM BY. Risk Management Analyst POLICY NUMBER: GLO 1817406-02 COMMERCIAL GENERAL LIABILITY CG 25 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EACH LOCATION, OTHER THAN CONSTRUCTION PROJECTS, OCCUPIED BY THE NAMED INSURED A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I —Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to operations at a single designated "location" shown in the Schedule above: 1. A separate Designated Location General Aggregate Limit applies to each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of 'bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". & Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Location General Aggregate Limit for that designated "location". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Location General Aggregate Limit for any other designated 'location" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Location General Aggregate Limit. CG 25 04 05 09 ® Insurance Services Office, Inc., 2008 RieleMnugementD'nielan RE\nt�vm & MPRwm Br: Risk Management Malys[ B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I —Coverage A, and for all medical expenses caused by accidents under Section I —Coverage C, which cannot be attributed only to operations at a single designated 'location" shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Location General Aggregate Limit. C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Location General Aggregate Limit. D. For the purposes of this endorsement, the Definitions Section is amended by the addition of the following definition: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III —Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 ® Insurance Services Office, Inc., 2008 Rlek Mmmgm%ent Dhb[crn +9 REVI &APPRO BY: Risk Management Analyst e Other Insurance Amendment — Primary And Non - Contributory a ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add1. Prem Return Prem. GLO 1817406-02 1 10/01/2020 10/01/2021 10/01/2020 75272000 N/A N/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 policy provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available 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. Includes copyrighted material of Insurance Services Office, Inc., with its permissior xlsk Management Dhisian REVie &APPROVm Br. `if `. F" .� z � Q ®, ® Ruk Management Analyst POLICY NUMBER: GLO 1817406-02 COMMERCIAL GENERAL LIABILITY CG 24 1710 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTUAL LIABILITY - RAILROADS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Scheduled Railroad: Designated Job Site: SLL CONTRACTS FOR WORK DONE FOR RAILROADS, AS REQUIRED BY WRITTEN (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to operations performed for, or affecting, a Scheduled Railroad at a Designated Job Site, the definition of "insured contract" in the Definitions sec- tion is replaced by the following: 9. "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or or- ganization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an in- demnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for 'bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to pre- pare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifi- cations; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the in- sured's rendering or failure to render pro- fessional services, including those listed in Paragraph (1) above and supervisory, in- spection, architectural or engineering activi- ties. CG 24 1710 01 © ISO Properties, Inc., 2000 n.s'�=n7 Risk M0VgemmtDMsiom leiCCRE e&M & pAPPROVED BY. Risk Management Malyst POLICY NUMBER: GLO 1817406-02 COMMERCIAL GENERAL LIABILITY CG 2414 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF GOVERNMENTAL IMMUNITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART We will waive, both in the adjustment of claims and in the defense of "suits" against the insured, any governmental immunity of the insured, unless the insured requests in writing that we not do so. Waiver of immunity as a defense will not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. CG 24 14 04 13 © Insurance Services Office, Inc., 2012 Risk MWMgernent DMsimt Al 7- REVIEWED&APPROVEDBY: `!1,3Il 14, F�,R. Vt IA, ®, Risk Management Analyst POLICY NUMBER: BAP 1857085-02 COMMERCIAL AUTO CA20481013 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 an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 „� Rkk Mnnag�mwdDhislnn ,REMe & Aeraov® ar 41yiL111, Risk Management Analyst NOTICE OF COMPLIANCE Contractor Tetra Tech, Inc. Name: Project A-2018-160-02A Number: Project Extension of Agreement to Provide On-Call Engineering Name: Services for Water Resources Agreement No. A-2018-160-02 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: POLICY EXPIRATION TYPE OF INSURANCE COI DATE FILE NAME NUMBER 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 City of Santa Ana- WC185708704 10/01/2023 09/27/2022 EMPLOYERS' LIABILITY 570095585268.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 10/19/2022 1:05 PM