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HomeMy WebLinkAboutADAMS STREETER CIVIL ENGINEERS, INC.INSURANCE NOT ON FILE WORK MAY NOT PROCEED CLERK OF COUNCIL A-2021-085 z DATE: -' O;P A(1.)(P�rict^ni )L6AGREEMENT TO PROVIDE ON -CALL DEVELOPMENT PLAN CHECKING SERVICES FOR WATER RESOURCES DIVISION THIS AGREEMENT is made and entered into this I st day of June, 2021 by and between Adams Streeter Civil Engineers, Inc. ("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. On February 25, 2021, the City issued Request for Proposal No. 21-020, by which it sought a qualified contractor to provide on -call development plan checking services for the Water Resources Division of the City's Public Works Agency. B. Contractor submitted a responsive proposal that was selected by the City. Contractor represents that it is able and willing to provide the services described in the scope of work that was included in RFP 21-020. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional contracting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES On an on -call basis, and at the City's sole discretion, Contractor shall perform the services described in the scope of work that was included in RFP No. 21-020, which is attached as Exhibit A and incorporated in full, and as further described in Contractor's Proposal, which is attached as Exhibit B and incorporated in full. 2. COMPENSATION a. City neither warrants nor guarantees any minimum or maximum compensation to Contractor under this Agreement. Contractor shall be paid only for actual services performed under this Agreement at the rates and charges identified in Exhibit C. The total annual sum to be expended under the term of this Agreement, including any extension periods, shall not exceed $150,000. b_ Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals and Scope of Work, which may reasonably be expected by City. Page 1 of 8 3. TERM This Agreement shall commence on the date first written above and terminate on May 31, 2024, unless terminated earlier in accordance with Section 17, below. The term of this Agreement may be extended for one 2-year period upon a writing executed by the City Manager and City Attorney. 4. PREVAILING WAGES Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. If the services being performed are part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. 5. INDEPENDENT CONTRACTOR Contractor shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 6. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. Page 2 of 8 7. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Contractor's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. C. Worker's Compensation Insurance. In accordance with the California Labor Code, Contractor, if Contractor has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. If Contractor is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall he furnished to the City upon execution of this Agreement and shall be approved by the City. (iii) Certificates and policies shall state that the policies shall not be cancelled or reduced in coverage or changed in any other material aspect, by contractor, without thirty (30) days prior written notice to the City. (iv) Contractor shall supply City with a fully executed additional insured endorsement. Page 3 of 8 If Contractor fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 8. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Contractor further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs far special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. 9. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor shall defend, indemnify and hold harmless the City, its officers, agents, representatives, and employees against any and all liability, including costs, and attorney's fees, for infringement of any United States' letters patent, trademark, or copyright contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 10. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements Page 4 of 8 charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. 11. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information' shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality, (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 12. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interest and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 13. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax 714- 647-6956 Page 5 of 8 Executive Director Public Works Agency City of Santa Ana 20 Civic Center Plaza (M-21) P.O. Box 1988 Santa Ana, CA 92702 To Contractor: Adams Streeter Civil Engineers, Inc. 16755 Von Karman Avenue, Suite 150 Irvine, CA 92606 Attn: Khoon Tan, P.E., Director of Municipal Services A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these timeframes, weekends, federal, state, County or City holidays shall be excluded. 14. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any parry, or anyone acting on behalf of any party, which are not embodied herein. 15. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other contractors retained by City. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or Page 6 of 8 granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 18. NON-DISCRIMINATION Contractor shall not discriminate because of race, color, creed, relation, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities or in connection with any activities under this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 19. JURISDICTION -VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 20. PROFESSIONAL LICENSES Contractor shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the service$ hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. Page 7 of 8 A-2021-085 21. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. All exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written, ATTEST: //'Daisy Gomez Clerk of the Council APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By:.� hn M. Funk Sr. Assistant City Attorney RECOMMENDED FOR APPROVAL Nabil Saba, PE Executive Director Public Works Agency CITY OF SANTA ANA ri tine Ridge City Manager CONTRACTOR VZW� - Name: Nick Streeter Title: Vice President Pnge 8 of 8 CITY OF SANTA ANA EXHIBIT A RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES A. Introduction The Water Resources Division of the Public Works Agency is committed to providing the highest quality drinking water systems and sewer collection and conveyance systems. It is also the Division's goal to provide the highest level of responsiveness, professionalism and customer service to the residents and businesses of Santa Ana. To pursue this mission, the Water Resources Division is issuing this Request for Proposal (RFP) for On -Call Water Resources Development Plan Checking Services to assist City staff in maintaining an efficient Water Resources Development Services program. Continuous and timely interaction with our residents and customers, efficient checking and processing of Developer requests is paramount to the success of the Public Works Agency vision. The work that will be performed by the selected Consultant(s) is essential to the City's ability to help provide an effective and efficient Water Resources Division Development services- B. Background The City of Santa Ana is located in the County of Orange in Southern California. The City encompasses 27.2 square miles and a population of 332,318 people. The Water Resources Division is a part of the City's Public Works Agency and oversees and maintains the daily operations of the public domestic water system and sanitary sewer system. The City of Santa Ana's water system is comprised of approximately 478 miles of water main, 45 MG of storage at 5 sites, 7 Metropolitan Water District connections, 21 groundwater wells, 7 pump stations, 4 pressure regulating stations and utilizes 2 pressure zones. The City's sanitary sewer system has approximately 9,000 manholes, 400 miles of sewer mains and 2 lift stations. The sewer system collects all sewage and transports it to the Orange County Sanitation District for treatment. The Water Resources Division administrative and engineering section is tasked with reviewing, checking and regulating all proposed developments within the City limits as it pertains to the City's water and sewer infrastructure. The Water Resources Division staff members review development applications to determine the impact of proposed developments on City domestic water and sanitary sewer infrastructure. Applications for subdivision, use permits, lot line adjustments, grading permits are reviewed and Conditions of Approval are prepared to mitigate development impacts. Water service application processing and plan checking assure that the development of public improvements is accomplished in accordance with applicable local, county and state requirements. Staff reviews improvement plans, subdivision maps, improvement agreements, legal descriptions, deeds and offers of dedication associated with a wide range of development projects. Staff coordinates with other City departments, agencies and utility companies as well as provides assistance to private developers and the general public as required throughout the development process. Page I of 7 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES C. Work Description The project consists of providing on -call consultant services in private development review and plan check for the Water Resources staff from up to three (3) professional civil engineering firms, essentially serving as an "extension" of staff for a three-year period for a not -to -exceed amount of $150,000 annually. The City will retain an option for a two-year renewal period. When requested from The City Water Resources Division, the consultant shall provide a scope of work, budget, and schedule for each task. The Consultant shall identify the work to be done, as well as, all task deliverables from the consultant. The Consultant shall not charge or invoice the City for its cost in developing scope proposals. The Consultant shall be expected to check plans in conformance with the following standards: The City of Santa Ana Water Resources Standard Plans https: //www. santa-a na. org/pw/water-and-sewer/water-services/water-con stru cti on -standards The City of Santa Ana Design Guidelines for Water and Sewer Facilities 2020 https://www.santa- ana.org/sites/default/files/pw/documents/Design%2OGuidelines%2OComplete%2OFina1%2020 1124. pdf The City of Santa Ana Cross -Connection Control and Backflow Prevention Program https://www. santa-ana. orq/pw/water-and-sewer/water-services/cross-connection-control-and- ba ckflow-prevention-pros ra m The City of Santa Ana Sewer System Management Plan https://www.santa-ana.org/sites/default/files/pw/documents/SSMP-2020 pdf https://www.santa-ana.org/sites/default/files/pw/documents/Revised SSMP 9-1-2020- Appendices.pdf The City of Santa Ana 2017 Water Master Plan https://www.santa-ana.org/sites/default/files/Documents/2017WaterMasterPlan pdf The City of Santa Ana 2016 Sewer Master Plan https://www.santa- ana.org/sites/defaulVfifes/Documents/SantaAna Sewer MasterPlan Report 011717.odf The Standard Specifications for Public Works Construction (The "Greenbook") 2018 Edition D. Core Requirements and Deliverables (Time and material and/or fixed fee) Consultant shall provide the following deliverables in accordance with established procedures as dictated by the Project Manager or designee. Turnaround time shall not exceed 8 working days per assignment unless otherwise approved by the Project Manager or designee. The Consultant is expected to be knowledgeable in plan check engineering, especially as it relates to sewage systems, FOG control and public water systems. Page 2 of 7 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES Engineering Plan Check of Private Development Proiects The Consultant(s) shall review private development improvement plans for technical correctness and conformance with general engineering principals, state law, the City Municipal Code and Standards, conditions of approval and approved subdivision maps. The Consultant(s) shall review dry utility improvement plans for technical correctness and conformance with general engineering principals, state law, the City Municipal Code and Standards, and any other conditions that are pertinent to the proposed project. The Consultant(s) shall review studies, reports, geotechnical reports and/or materials associated with development projects including, but not limited to improvement agreements, legal descriptions, deeds, offers of dedication and CEQA documents. The Consultant personnel assigned will review estimates, design drawings, maps and other related documents for compliance and conformance with the City of Santa Ana Water Resources Design Guidelines. The Consultant shall also perform field investigations as part of the review and attend meetings when requested by the City. The Consultant shall identify utility, environmental and/or regulatory constraints that may influence the design of the project. The Consultant shall be required to use the Water Resources Division's Field Data acquisition software, infraMAP, to assist them in plan review and coordinate with the City as necessary for all engineering checks. The City shall provide access and training for this software tool. Hours spent on each submittal shall be logged and submitted to the City with the return of each plan check for project and program tracking. The Consultant shall return all plans with corrections to the City. Written evaluations with engineering recommendations to ensure submissions conform to engineering design standards, policies and industry practices for all assigned work shall be provided with each submittal return. The Consultant shall also deliver monthly status reports of all assignments detailing each project, submittal number and correction status. This report shall also provide budgetary status of each project. E. Technical Abilities Proposer must demonstrate the following skills: Accomplished knowledge in the field of engineering plan check services. 2. Knowledge of the City's Municipal Code, Subdivision Map Act, state and local regulations as it pertains to developments Page 3 of 7 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES If required, the Proposer shall also use any plan checking software that the City Water Resources Division implements such as Bluebeam or other software. F. Cooperative Work Environment It is required that successful proposer(s) be able to work together in a cooperative work environment with the program manager/contract administrator and staff, and other consultants as required. G. Ongoing Coordination/Status Meetings During the term of the contract, the Project Manager reserves the right to schedule periodic meetings (anticipated to be once per quarter). H. Content The City retains control over all creative content, and is responsible for providing existing creative content to the Consultant. The City will work with the Consultant(s) to develop any new creative, including public service announcements, display ads, collateral materials, etc., as well as the technical and knowledge support required to execute any advertising activities. The City will be the sole authority in determining acceptability of Consultant(s) work product. I. Value Added Services Proposers are encouraged to list and describe any value added services that can be offered to the City as part of their proposal that will aid in the City's endeavors for this request for proposals. Page 4 of 7 TABLE OF CONTENTS i COVER LETTER ............................. ...................... ---`.----,.---.--,--,—% U. COMPANY OVERVIEW .................................... ............................ -----,--,--.-3 Ui TEAM SUBC[)NSULT/\NT.... ___ ....... ........................................... ----.--.—,,--�5 0/� FIRM AND TEAM EXPERIENCE .... —... ...................................................... --.---..-8 V. OVERALL APPROACH ........ .-.................. -.............. -----`----.--.--,--Q \4. SCOPE (}FSERVICES. ... .............. .... --........ ..-----`-----`--,--`--`�g V|i RELEVANT PLAN CHECKING EXPERIENCE AND REFERENCES ................... —.--�11 VUi AGREEMENT ST/\TEK8ENT--............... ............. ................ ................ —..... ................. 14 |X. FEE PROPOSAL ................................... ....................................................... ............... ...... 14 APPENDIX A. NON -COLLUSION AFFIDAV|T-....... ....................................... ~.................... .......... .'i0 B. NON -LOBBYING CERT|FICATI(}$!—'... ............. ............................................ ......... '17 C. N{)N'D|SCR|M|NATION CERTIFICATION ............... —................................................ 18 Page I. COVER LETTER March 18. 2021 CIS ADAMS STREETER City of Santa Ana Public Works Agency 215 South Center Street Santa Ana, California 92703 Attn: Rodolfo Rosas, P.E. SUBJECT: Proposal to Provide On -Call Water Resources Development Plan Checking Services (Request for Proposal No. 21-020) Dear Mr. Rosas, Adams Streeter Civil Engineers appreciates the opportunity to submit our Proposal to the City of Santa Ana to provide "On -Call" Water Resources Development Plan Checking Services. In conformance with the Request for Proposal (RFP) requirements, a Technical Proposal and Fee Proposal is provided separately through the PlanetBids system for the City's consideration. We are committed to working seamlessly with your staff and have the expertise and resources necessary to assist the City in providing the necessary services in a timely, efficient and cost-effective manner. Adams Streeter is financially solvent and is not in any condition such as bankruptcy, pending litigation, planned office closures, impending merger, etc., that may impede our ability to complete the required RFP scope of work. This Proposal is also made without collusion with any other person, organization or party submitting a proposal and it is in all respects fair and in good faith without collusion or fraud. This Proposal shall remain valid for a period of not less than one hundred and twenty (120) calendar days from the date of submittal. The signer of this Proposal has the full authority to bind Adams - Streeter. The point of contact during the proposal evaluation period who will be authorized to make representations for the organization is as follows: Adams Streeter Civil Engineers, Inc.. 16755 Von Karman Avenue, Suite 150 Irvine, California 92606 Attn: Khoon Tan, P.E., Director of Municipal Services Office: (949) 474-2330 x231, Cell: (949) 390-0984, Email ktan(&adams-streeter.com Thank you for this opportunity to be of service to the City of Santa Ana. Please don't hesitate to contact Mr. Tan for any questions about any portion of this Proposal during the evaluation period. Sincerely, 6P�v� Randal L. Streeter President / Principal In -Charge Page 2 II. COMPANY OVERVIEW AREAS OF EXPERTISE CIVIL ENGINEERING & LAND SURVEYING SELECT AWARDS HomeAid Orange County & OC United —Recognition of Contribution to the OC United THRIVE Quad Development, 2019 Family Assistance Ministries & HomeAid Orange County — Recognition of Contribution to the Calle Canasta House, 2016 American Society of Civil Engineers, Orange County Branch — Land Development Project of the Year Award for Lambert Ranch, 2013 American Public Works Association, Southern California Chapter-2015 Storm Water Quality Project of the Year for the Glassell Campus LLD Retrofit & Parking Rehabilitation Project American Society of Civil Engineers, Orange County Branch — 2017 Outstanding Sustainable Engineering Project, 2017. American Society of Civil Engineers, Region 9 (CA) — 2010 Outstanding Community Improvement Project for the Irvine Ranch Outdoor Education Center Orange County Engineering Council — 2010 Engineering Project Achievement Award for the Irvine Ranch Outdoor Education Center I FIRM BACKGROUND I I EXPERIENCE I I CAPABILITIES Adams Streeter is founded bylan Adams and Randal Streeter in 1981, and is headquartered in Irvine, California. The firm is a small business enterprise with aver 38 years of experience and specializes iin private and public - realm design through Innovative and cost- effective design solutions for dozens of public municipalities and private entities throughout California. The firm is currently staffed by twenty-three employees, comprising of fourteen civil engineers and technicians, six surveyors and mappers, and three administrative staff. Parks, Open Space & Trails Street Beautification, Improvement, Rehabilitation Public Facility Improvements and Renovations Office and Retail Facilities Single and Multi -Family Residential Developments Urban In-Fill/Mixed-Use Developments Affordable Housing Campus Housing Planning and Design Commercial and Industrial Site Development Retail Site Development Public and Commercial ADA Upgrades Streetscape and Parking Lots Parks & Open Space Low Impact Development, Stormwater Management and Water Quality Hydrology and Hydraulics Site Development, Planning and Due Diligence Site Grading & Earthwork Site ADA Evaluations Storm Drainage and Sanitary Sewer Domestic and Reclaimed Water Plan Check / Plan Review Boundary Surveys, Land Title Surveys, Topographic Survey, Construction Staking, As -built Surveys and Mapping Services 157S5 VON BARMAN AVENJE. SUITE 150. 19V tJi cA 92606 i59 471 310 1 ADAMS SIRE -TER cam Page 3 ASCE BUSINESS INFORMATION Company Legal Name: Adams Streeter Civil Engineers, Inc. 16755 Von Karman Avenue, Suite 150 Irvine, CA 92606 Organizational Structure: California "C" Corporation State Entity Number: C1014113 Certification Small Business Enterprise (Certification No. 59891) Years in Business: 40 Years Company Officers: Jan A. Adams (Chief Executive Officer), Randal L. Streeter (Secretary), Linda I. Adams (Chief Financial Officer) Adams Streeter Civil Engineers (ASCE) is a full -service civil engineering and land surveying firm that specializes in project delivery for local and regional public agencies, special districts and private developers, and have been providing civil engineering and surveying services in Southern California since 1981 to both our public and private sector clients. ASCE is a California "C' corporation that was incorporated in January 8, 1981 by Jan Adams and Randal Streeter and is a small business enterprise (SBE) based in Irvine, California. Over the last 40 years of business, the company has earned a reputation for thoroughness, rapid turnaround, cost efficiency and overall quality of work and is one of Orange County's premier firms for civil engineering and surveying services. ASCE takes pride in the fact that ninety percent of our business comes from repeat clientele due in part to our quality of work, competitive prices and our ability to meet deadlines. ASCE have extensive experience and a proven track record in providing Public Works related services encompassing the civil engineering, surveying and mapping fields to various cities, municipalities and districts including, but not limited to the following: City of Aliso Viejo City of Newport Beach Chino Basin Desalter Authority City of Anaheim City of Orange Eastern Municipal Water District City of Buena Park Coast College Irvine Ranch Water District City of Diamond Bar Concordia University Irvine Campus Housing Authority City of Fullerton City of Perris Jurupa Community Services Dist. City of Garden Grove City of Redlands Long Beach City College City of Hermosa Beach City of Riverside Orange County Water District City of Huntington Beach City of San Clemente Santa Margarita Water District City of Irvine City of San Juan Capistrano Riverside County Flood Control District City of La Habra City of Tustin Trabuco Canyon Water District City of Laguna Niguel City of Villa Park University of California, Bakersfield City of Lake Elsinore City of Yorba Linda University of California, Irvine City of Loma Linda CALTRANS Vanguard University City of Mission Viejo County of Orange City of Moreno Valley County of Riverside ASCE have also provided services on numerous development and facility improvement -based projects (residential, commercial, industrial) that involves extensive public/municipal support infrastructure improvements to private clients including, but not limited to the following: 16 755 VON AAAMAN AVE NJ E. SW TE 15G, IRV iNE CA 92505 : 119111 .330 1 AOAMS 5'REETER COM Page Amgen Irvine Unified School Dist. Sukut Construction Armada, LLC John Laing Homes SunCal Companies Arnel Development Joseph Nicholas Homes Sunrise Communities Artisan Communities K. Hovnanian Companies Taylor Morrison Homes Barratt American Kaufman & Broad The Garrett Group Baywood Development Keystone Pacific The Irvine Company Boeing Realty Corporation Kell Company The Olson Company Brookfield Homes Lambert Ranch Valeo Companies CalAtlantic Homes Lennar Communities Warmington Homes California Pacific Homes Mastercraft Homes William Lyon Homes Centex Homes MBK Homes Catalina Freight Line Citation Homes Oak Tree Industries Schafer Logistics Cook Hill Properties 0 Hill Partners Travis Companies, Inc. D. R. Horton Homes Pacific Communities Urban Commions Fieldstone Development Pardee Construction Ferrado Griffin Communities Pulte Homes Shlemmer Algaze Assoc Habitat for Humanity Rancho Mission Viejo Co TD Architects, Inc. Irvine Apt. Communities Red Mountain Retail Group Trice Realty Irvine Community Dev. Richmond American Homes Ware Malcomb Architect California Building & Grand Valley Healthcare The Irvine Ranch Outdoor Education Maintenance Industries, Inc. Skilled Nursing Facility Center Coast to Coast Commercial, LLC Newport Partners, LLC Santa, Margarita Ford ASCE brings over40 years of experience working concurrently with public agencies and private entities and is very familiar with the development plan check process. ASCE is well qualified and capable to perform the required work and is confident in our ability to provide exceptional services to the City of Santa Ana in a timely and cost-effective manner. Ill. TEAM SUBCONSULTANT IGong Enterprises (GEI) sole business model since its founding in C)NG ENTERPRISES, NC. 1989 is providing professional plan check services to municipal governments in the Southern California region with a motto for "thoroughness and attention to detail". For over 32 years, GEI has provided professional plan check services to numerous municipalities throughout Southern California, including for City of Moreno Valley, City of Brea, City of San Juan Capistrano, City of San Clemente, City of La Habra, City of Santa Ana, City of Mission Viejo, City of Orange and City of Irvine. Kenneth Gong, the firm's founder and president is directly involved in the "day-to-day" plan checking process and have reviewed a myriad of projects including residential tract developments, commercial developments, multi -use site developments, single infill lot redevelopments, and industrial site developments. GEI also has a high degree of expertise in the area of flood control and storm drainage for regional, master planned, and local drainage facilities. GEI's office is located at 7755 Center Avenue, Ste. 1100, Huntington Beach, CA 92647, and can be reached during normal business hours at (714) 372-4959. _ Page 5 IV. FIRM AND TEAM EXPERIENCE Key personnel are assigned based upon their experience, project management abilities, technical/design competency, and prior involvement with projects of similar scope and prior experience with the public and private sectors. A brief overview the key personnel that will be managing and performing the assigned plan checking tasks are as follows: Khoon Tan, PE, QSD • Seasoned project manager with broad knowledge and hands-on Director of Municipal experience in engineering design and construction with 33-years of Services and Senior industry experience. Project Manager • Public -sector practice including 10-years of public agency experience in managing capital improvement projects and construction, including for sanitary sewer, domestic / reclaimed water, and storm drain infrastructure improvements, local / arterial streets and state highway improvements and rehabilitation, parks and open space development. • Private -sector practice includes 23-years of experience in the management, design and construction of public infrastructure improvements involving wet utilities, streets, pavement rehabilitation, parks, etc., and commercial, residential, and industrial site development. • Bachelor of Science in Civil Engineering, Oklahoma State University, Oklahoma; Registered Civil Engineer (CA RCE 60131); Qualified SWPPP Developer / Practitioner (No. 20862). Mo Abadi, PE • Seasoned and highly experienced project manager with 37-years of Senior Project engineering design and construction experience. Manager • Extensive technical expertise in infrastructure planning, subdivision and industrial site development encompassing site planning, grading, storm �- drainage, sewer and water facilities, roadway improvements, hydrology and hydraulics analysis, and water quality compliance. • Experienced in implementing improvements involving complex wet and dry utility alignments, design and demand analysis, such as for the Boeing Company facilities in Huntington Beach, Seal Beach, Long Beach, Torrance, Monrovia and Santa Ana. • Bachelor of Science in Civil Engineering, University of California, Irvine, California; Registered Civil Engineer (CA RCE 42615). Felix Gonzalez, PE Director of Commercial Engineering and Sr. Project Manager • Experienced project manager with 30-years of industry experience. • Adapt in management and design of engineering projects for public and private land development projects ranging from residential to recreational facilities, and commercial property developments including for retail and fast-food chains to public utility agencies. • Extensive background in plan preparation and analysis of domestic water facilities and sanitary sewer improvements, street improvement and storm drain facilities along with rough and precise grading. • Well versed with site accessibility requirements for public improvement and commercial projects. • Bachelor of Science in Civil Engineering, California State University of Long Beach with emphasis in Water Resources; Registered Civil Engineer (CA RCE 67660). �, �„ :r �•.Page !nneth Gong, PE • Experienced plan checker with 32-years of experience and a total of 37- President years of industry experience. • Public -sector practice including 9-years with OC Flood Control, OC I Subdivision Division, and OC Lab. • Private -sector practice includes providing plan check services to various municipalities in Southern California with specific expertise in the review and analysis of drainage facilities. • Strong track record in consistent delivery of plan check reviews within _ time frame commitments. • Bachelor of Science in Civil Engineering, University of California, Irvine, California; Registered Civil Engineer (CA RCE 36494); General Contractor, B Classification. As a full -service engineering firm, ASCE have provided a wide array of professional engineering, mapping, survey, plan/map checking, and other services to various • municipalities and private clients for the past 40 years. GEI have focused exclusively on providing professional plan checking services to various municipalities over the past 32 years, developing long-standing clients including for City of Moreno Valley (18 years), City of San Clemente (32 years), and City of San Juan Capistrano (30 years). Projects reviewed include residential tracts, commercial, multi -use, infill and industrial sites that typical includes rough grading, precise grading, street, storm drain, sewer and water, drainage reports, soils reports, structural calculations, subdivision tract maps and parcel maps. Tract and parcel maps are reviewed for the procedure of survey, completeness and accuracy of data notation, mathematical closure, dedication and easement provisions, and legal description in compliance with the Subdivision Map Act, the Land Surveyor's Act, the approved Tentative Map, the approved Conditions of Approval, and the current title report. Our expertise also includes the review of Flood Control and Storm Drain projects at the Regional, Master Planned, and Local Drainage levels inclusive of storm drain facilities (pipes, box culvert, channels, etc.), hydrology reports (i.e., existing / developed / interim conditions, detention basin and routing analysis, etc.), hydraulic calculations (i.e., pipe and catch basin sizing, street flooding analysis, etc.) and WQMP reports. ASCE's capabilities as a full -service engineering and surveying firm along with GEI exclusive plan checking background affords us the expertise and resource to provide the City with exceptional on -call plan check / plan review services. = ASCE have an excellent and long-standing relationship with Gong Enterprises (GEI) and • have in the past provided professional plan check services on numerous development 6 projects concurrently for the City of San Juan Capistrano. ASCE and GEI (as a team sub - consultant under ASCE) are also currently providing on -call project engineering services at the Orange County Great Park for the City of Irvine (inclusive of plan checking services), and are separately assisting the City of Santa Ana Public Works Agency in providing on -call development plan checking services to the Water Resources Division. ASCE in conjunction with GEI, our team subconsultant not only affords us the background, knowledge and expertise to discern technical design and constructability related issues, but also a thorough understanding of the intricacies and potential challenges that can emerge during the plan review process. Both Mr. Tan and Mr. Gong's public service backgrounds also provides an understanding from both private and public sector perspective. As shown above, the team directly responsible for the work will comprise of highly qualified senior -level professionals that utilize a balanced and comprehensive approach to the plan checking process. Aside from technical plan review, progress monitoring/tracking and Quality Assurance and Quality Control (QA/AC), the team will also seek to identify, document and communicate any other potential issues that may affect the project to City staff for further coordination and collaboration as needed. Key staff n; Page 7 members will also attend meetings and/or participate in teleconferences to discuss and resolve plan related issues with City staff and the applicants, as necessary. An overall project team organization chart identifying communication/reporting relationships and key personnel that will perform the work, including each individual's time that is anticipated to be devoted to this project is provided as follows: Khoon Tan. PE. QSD/P 25% ADAMS STREETER `ON4 ENTERPRISFS. 1W. MOAbadl. PE 20% Felix Gonzalez. PE 20% Kenneth Gong. PE 25% (`) Proiect Management. Oversight and City Liaison: All project engineering services provided under the leadership of ASCE will be managed by Mr. Tan, who is also the designated City liaison. Mr. Abadi, the designated technical and production manager, will also serve as the secondary liaison to the City for redundancy. ASCE and GEI have committed the specific personnel as indicated on the overall project team organization chart above to perform the City -assigned plan checking work. However, additional ASCE staff resource is available to the City and can be called upon to assist, if needed. In addition to the company's two founding engineering principals, ASCE is currently staffed with a total of nine civil engineers, four engineering technicians / CAD personnel and four administrative personnel, including for six survey personnel (or three 2-man survey crews) and a mapping professional that can be called upon as additional resource or for support. ASCE wild respond to the City's needs with minimal notice, assign appropriate staff engineer(s) and/or technician(s) based on the nature of work involved, and manage/oversee all assigned task orders. V. OVERALL APPROACH ASCE utilizes experienced and qualified professional staff ` as opposed to junior -level staff to perform plan checking services. To ensure milestones and deadlines are adhered to, staff workloads and project specifics are m monitored to meet the turnaround schedules. Assigned reviewers are also maintained for the course of the project. We would typically respond within one day or less to , discuss the specific requests and any required accelerated turnaround schedule. To manage backlog that may occur due to unforeseen circumstances, lost work T, hours will be made-up by allocating additional resources to the project. All incoming and outgoing plan check submittals to / from the City will be logged into a MS Excel spreadsheet for documentation purposes and to track dates, progress status, turnaround times, budgets, etc. The Water Resources Division's Field Data acquisition software, infraMAP that is Page 8 being used by the Division's field crews to update field information, will also be utilized by the team as part of the plan checking process to obtain available information on the City's existing sewer and water infrastructure including for scanned atlas drawings / as -built plans, sewer CCTV records, foreman cards, etc. All assigned ASCE and GEI staff are proficient in using the infraMAP software and will not require any additional training in utilizing this software tool for plan checking purposes. Deliverables will typically comprise of comprehensive plan redlines and comments letters that are provided in electronic format (PDF) utilizing the Bluebeam and MS Word software, and securely transmitted on- line utilizing LiquidFiles, which effectively eliminates the time associated with the handling and delivery of hardcopy media. Hours spent on each submittal will be logged and submitted to the City with the return of each plan check to facilitate project and program tracking by City staff. A spreadsheet with logged information of all plan check assignments and corresponding budgets will also be provided to the City each month. The typical turnaround time is eight (8) working days with a goal to complete each plan check within three (3) plan check cycles. VI. SCOPE OF SERVICES The scope of work anticipated for this endeavor would generally include the review of various private development plans (residential, commercial and industrial / other developments), and wet / dry utility improvement plans by other utility purveyors, as it pertains to the City's sewer and water facilities. Residential related development is anticipated to include small Accessory Dwelling Units (ADU's), apartment complexes, and residential subdivisions consisting of single-family, condominiums, town - homes and flats. Commercial developments may include business / retail facilities (shopping and strip malls, fueling stations, mini -marts, etc.), distribution hubs, medical and utility support buildings, and other facilities. Other non-profit public service and religious facilities such as churches, support offices, homeless shelters, affordable housing, food bank facilities, etc., are also anticipated. Typical plans anticipated for review of these development includes sewer and water (domestic, potential reclaimed and fire) plans, street improvement plans, storm drainage plans, dry utility improvement plans, site utility plans, grading plans (precise, rough, mass), and may require review of appurtenant documents such as Conditions of Approvals (COA), Tentative Tract / Parcel Maps (TTM / 15755 vJN KAQAAAN AENJE, SU!'E 150.'RV NE. CA 92006 1 9.14 41,1 23 30 1 malt S°NEE?Ea iAM Page 9 TPM), easements documents, plats, plumbing, fire, dry utility plans and other documents as provided in the RFP Appendix (Attachment 1, Page 3 of ). As it pertains to the City's sewer and water facilities, addressing specific concerns of the Water Resources Division will be imperative. The review of sanitary sewer systems would generally include mainline and lateral design, materials, fittings, manholes, clean -outs, gas venting, backflow preventers, and other related appurtenances. The review of water improvements may involve domestic, reclaimed (limited per City infrastructure) and fire water design, materials, fittings, hydrants, air blow -offs / air and vacuum release valves, gate / butterfly valves, backflow preventers / detector checks, domestic and irrigation meters, and other related appurtenances. Typical item requirements to address general and specific Water Resources Division's concerns may include, but not limited to the following: 1. Conformance with the latest revision of the City's Design Guidelines and Standard Drawings for Water and Sewer Facilities dated November 2020, including typical requirements such as for the inclusion of the latest standard water and sewer notes, utilizing standard construction notes/format, identification of applicant and engineer of record, legal description listing, drafting standards, etc. Specific department provisions may include items ranging from a signature block placement for the Water Resources Manager on the plans to specific provisions for lateral service connections to mainline depending on pipe size and material (hot taps, tee -cuts, etc.) 2. Identification of all existing publicbprivate water and sewer mainlines and service laterals, lateral centerline stationing, pipe size and material, meter size, location of sewer manholes and cleanouts, fire hydrants, backflow devices and easements on plan; identification of all proposed service lateral locations including centerline stationing, pipe size, material and slopes. 3. Verification of proposed meter and lateral sizing (demand calculations), development contribution to sewer mainline, adequate line pressures for domestic water and fire service (pressure information on meters, hydrants, valves, etc., via the Automated Meter Infrastructure deployment or AMI when implemented by City), minimum horizontal and vertical pipe separations, minimum pipe cover, allowable pipe material specification, backflow protection for fire lines, potential dry/wet utility conflicts, sewer backflow and water pressure regulator valves, abandonments of existing unused services at the mainline, OCFA fire sprinkler requirements, manhole and cleanout placements, meter vault placements and clearances, facility placements within public/private property and easements, approved backflow devices, trenching and repairs, and other appurtenances. 4. Specific water provisions such as allowance for 1" to 2" water service hot -taps to concrete (ACP) or steel mainlines with mandated joint -to -joint replacement of ACP pipe section with PVC pipe and "tee" fitting for largerwater services; acceptable pipe material (PVC C900 DR-14); use of mechanical and flange joints as opposed to push -on connections; separate water (and sewer services) for commercial developments such as for services to individual units within a mini - mall (but case -by -case determination for high rise developments) with allowance for manifolds for 3" or larger service (per COA); no splicing of copper services; no deviation of sewer to water pipe separation (minimum 10' horizontal and 1' vertical between mainlines, and minimum 5' horizontal and V vertical between laterals) unless the deviation is cleared by Division of Drinking Water (DDW); abandonment of unused services to the corporation stop (per Sid. Plan); and use of combined water and fire service meters limited to a 1" combination meter only. 5. Specific sewer provision such as the use of transition couplers (Mission Clay) and stainless - steel bands for PVC lateral wye-connection to VCP sewer lines; acceptable pipe materials for sewer pipes (VCP or PVC SDR 26); minimum sewer (and water) separation from other utilities of 5' with separation of 2' to 3' acceptable for short segments only; sewer by-pass plans required for new 10" or 12" pipe connections; manhole use for 8" or larger laterals; construction potholing and CCTV required to locate utilities; and abandonment of unused services to mainline wye. Page 10 VII. RELEVANT PLAN CHECKING EXPERIENCE AND REFERENCES 1. Client: City of Santa Ana .1S GEI Address: 220 S. Daisy Avenue, M-85, Santa Ana, CA 92703 (City Corporation Yard) Name I Title: Mr. Brian Ige I Associate Engineer Phone I Email: (714) 647-3385 I bige@santa-ana.org Project Sampling: Amazon Delivery Station Project, Santa Ana Medical Office Building, Main Place Mail Redevelopment, North Harbor Village Affordable Housing 2. Client: City of Irvine AS GEI Address: 1 Civil Center Plaza, Irvine, CA 92606 Name I Title: Mr. Steve T'orelli I Manager, Administration and Operations Phone I Email: (949) 724-6361 I STorelli@cityofirvine.org Project Sampling: OC Great Park Western Sector Area Concept Design, Serrano Creek Channel Improvements, Administration Building Schematic Design Package 3. Client: City of Moreno Valley GEI Address: 14177 Frederick Street, Moreno Valley, CA 92553 Name I Title: Mr. Michael Lloyd, PE I Engineering Division Manager, Assistant City Engineer Phone I E-mail: (951) 413-3146 I MichaelL@moval.org Project Sampling: Moreno Valley Distribution Center: Precise Grading, Drainage, Parking Lot, Sewer, Water Improvements. Project Completed and Facility Operational. Moreno Valley Centerpointe: Precise Grading, Drainage, Detention Basin, Parking Lot„ Sewer and Water Improvements. Project Completed and Facility Operational. 4. Client: City of San Clemente GEI Address: 910 Calle Negocio, Suite 300, San Clemente, CA 92673 Name I Title: Mr. Tom Bonigut, PE I City Engineer . Phone I Email: (949) 361-6187 I BonigutT@San-Clemente.org Project Sampling: Ralph's Grocery Store: Precise grading and associated utilities. City approvedlpermitted plans and store is operation. Marblehead Planned Community: Rough grading, street, sewer, water, water quality and drainage. City approved/permitted plans, development of community is close to completion. 5. Client: City of San Juan Capistrano GEI Address: 32400 Paseo Adelanto, San Juan Capistrano, CA 92675 Name I Title: Joe Parco, PE I City Engineer Phone I Email: (949) 443-6353 I Jparco@sanjuancapistrano.org Project Sampling: Pacifica San Juan Planned Community: Rough Grading, Precise Grading, Retaining Walls, Street, Sewer, Water, Water Quality and Drainage Improvements. All Infrastructure Completed, Developer Proceeding w/ Sales and Construction of SFR's. 24-Hr Fitness: — Rough Grading, Precise Grading, Storm Drain, Sewer, and Water Improvements, Project Completed and Operational. 6. Client: City of Brea GEI Address: One Civic Center Circle, Brea, CA 92821 Name I Title: Ms. Hsing Chao I Associate Engineer Phone I Email: (714) 990-7606 I HsingC@ci.brea.us Project Sampling: Hines Development Expansion (40 Acre Multi -Phase In -Fill Project by Brea Mall): Offsite Street, Storm Drain, Signing and Striping Improvements. Page 11 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES APPENDIX ATTACHMENT 3: PROPOSER'S REFERENCES List and describe fully the contracts performed by your firm which demonstrate your ability to provide the supplies, equipment or services included in the scope of the proposal specifications, Attach additional Pages if reguired. The City reserves the right to contact each of the references listed for additional information regarding your firm's qualifications. Reference Customer Name: City of Santa Ana Contact Individual: Brian Ige Address: 220 S. Daisy Avenue, M-85 Phone Number: (714) 647-3385 Santa Ana, CA 92703 Facsimile Number: - Contract Amount: $50,000 Year: 2020 to present Description of supplies, equipment, or services provided: Plan checking services. Reference Customer Name: City of Irvine Address: 1 Civil Center Plaza Irvine, CA 92606 Contract Amount $300,000 (NTE annually) Description of supplies, equipment, or services provided: Reference Customer Name: City of Moreno Valley Address: 14177 Frederick Street Moreno Valley, CA 92553 Contract Amount: $100,000 (NTE annually) Description of supplies, equipment, or services provided: Plan checking services. Contact Individual: Steve Torelli Phone Number: (949)724-6381 Facsimile Number: - Year. 2019 to present Contact Individual: Michael Lloyd PE Phone Number: (951)413-3146 Facsimile Number. Brian Ige Year: 2003 to present :e �s5 V� N KARMA& Ave 4J� Su -E 15c. iAbENE CA s.aor, )19 „j 2330 1 ADAMS STREETER coM Page 12 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES Reference Customer Name: City of San Clemente Contact Individual: Tom Bonigut, PE Address: 910 Calle Negocio, Suite 300 San Clemente, CA 92673 Contract Amount: No stipulated limit of supplies, equipment, or services provided: Reference Customer Name: City of San Juan Capistrano Address: 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Contract Amount: No stipulated limit of supplies, equipment, or services provided. Reference Customer Name: City of Brea Address: One Civic Center Circle Brea, CA 92821 Contract Amount: $50,000 (NTE annually) of supplies, equipment, or services provided Phone Number (949)361-6187 Facsimile Number: - Year. 1989 to present Contact Individual: Joe Parco, PE Phone Number (949)443-6353 Facsimile Number: - Year. 1991 to present Contact Individual: Hsing. Chao Phone Number: (714)990-7606 Facsimile Number. - Year: 2017 to 2018 THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. i��ss FIN .:ARMAN Al,e NJ= sJ tin. IRV 4E CA 926)o : 9sa 4ra 2110 I Ao -%Is 5-a[ETER come Page 13 VIII. AGREEMENT STATEMENT ASCE concurs with the provisions as contained in the Standard Agreement provided in Attachment 4 of the RFP Appendix. IX. FEE PROPOSAL The fee proposal is electronically submitted concurrently with this technical proposal but as a separate PDF document to the PlanetBids system, in compliance with RFP requirements. The fee proposal includes ASCE's Standard Hourly Fee Schedule with positions and fees, and the completed Project Fee Schedule as provided by Attachment 2 of the RFP Appendix. The team acknowledge that price adjustments and final contract pricing may be negotiated by the City based on available funding. Page 14 APPENDIX • NON -COLLUSION AFFIDAVIT • NON -LOBBYING CERTIFICATION • NON-DISCRIMINATION CERTIFICATION :ON SARMAN AVENJ2 itl.-' 150 ARV-NF CA 92601 949 474 2130 1 ADAMs S-.UEETER COM Page 15 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non -collusion Affidavit is part of the Proposal. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed State of California County of O(LW Subscribed and sworn to (or affirmed) before me on this 1'5-_ day of YY1afilti , 204, by (Ui@hO A-tJQ5 %ems{ , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me T L3NDENEVEA "' Notiry Public-Gli}ornia }' pangs County _ Eommtuion r 2250629 My comm. Wrm hl lt. 2p22 r Nat ry PubljVSignature Notary Public Seal 162Si VON KARMAN AVENUE, SCHi E 1S0. kV'NE, CA 91606 1 949 471 1330 ! ADAMS S-IEETEB CO, Page 16 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES NON -LOBBYING CERTIFICATION The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose according / Signed: Title: President Randal L. Streeter Firm: Adams Streeter Civil Engineers, Inc. Date: March 8th 2021 15]SS VON ¢ARMAN AVEN'Ji. S'JI'; 150 4RV1.NE iA 92606 1 94) 47.1 2330 t ADAMS Com Page 17 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES NON-DISCRIMINATION CERTIFICATION The undersigned consultant or corporate officer, during the performance of this contract, certifies as follows: The Consultant shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The Consultant shall take affirmative action to ensure that applicants are employed, and that employees are treated during employment without, regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Consultant agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. 2. The Consultant shall, in all solicitations or advertisements for employees placed by or on behalf of the Consultant, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. 1 The Consultant shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Consultant's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Consultant shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Consultant shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Consultant's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Consultant may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. 1a7S5 VOW cAa5.3AN AVENJE. ;u,*E 150. IRVINe, CA 9250e 1 V 1) 47 L .330 j ADAMs i-REE*En CO.M Page 18 CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES The Consultant shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24,. 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Consultant becomes involved in, or is threatened with, litigation with a subconsultant or vendor as a result of such direction by the administering agency, the Consultant may request that the United States enter into such litigation to protect the interests of the United States. 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race., religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any consultant of public works violating this Section is subject to all the penalties imposed for a violation of the Chapter. Signed:i l Title: President Randal L. Streeter Firm: Adams Streeter Civil Engineers, Inc. Date: March 8th, 2021 162SS VON BARMAN AVENUE. SUITE 150, IRVINE,'A 92606 1 949 474 2330 1 AOAMS-STREEIER.;OM Page 19 EXHIBIT C FEE PROPOSAL Project Name: ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES RFP NO.: 21-020 Prepared for: CITY OF SANTA ANA Attn: Rodolfo Rosas, P.E. Project Manager Public Works Agency 215 South Center Street Santa Ana, California 92703 March 18, 2021 Prepared by: Adams -Streeter Civil Engineers AS ADAMS STREETER iL Engineers 15755 dcn Karman Ave. 5uite 150, Irvine, CA 92 COG 1 9494732330 1ds ms-s tree ter. com CITY OF SANTA ANA RFP NO.: 21-020 ON -CALL WATER RESOURCES DEVELOPMENT PLAN CHECKING SERVICES APPENDIX ATTACHMENT 2: FEE PROPOSAL Certification - I certify that I have read, understand and agree to the terms and conditions of this Request for Proposal. I have examined the Scope of Services (Exhibit A). I am familiar with all the existing conditions and limitation that may impact work requests. 1 understand and agree that I am responsible for reporting any errors, omissions or discrepancies to the City for clarification prior to the submission of my proposal. Proposer's fee proposal shall be submitted concurrently with the technical proposal, but in a separate file, clearly labeled as "Fee Proposal." This shall include the firm's Standard Hourly Fee Schedule with positions and fees and a Project Fee Schedule as listed below. All services performed by the consultant not specifically captured by the unit prices listed shall be compensated on a time and material basis: TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: ADAMS STREETER CIVIL ENGINEERS, INC. Item Description Unit Estimated Unit Price Total Quantity 1. Perform Grading Plan EA 10 $ 5,100 $ 51,000 Check for Single Family Residences (Assume 3 rounds of submssions prior to approval) 2. Perform Grading Plan FA 10 $ 1,650 $ 16,500 Check for Accessory Dwelling Units ((Assume 3 rounds of submssions prior to approval) 3. Perform Water/Sewer/Street HR 300 $ 150 $ 45,000 Improvement Plan Check 4. Perform Grading Plan HR 200 $ 150 $ 30,000 Checks for Commercial Developments 5. City Coordination Meetings HR 30 $ 150 $ 4,500 6. Field InspectionNerification HR 20 $ 150 $ 3,000 (As needed) TOTAL $ 150,000 i nese are esnmateo annual quantities. Actual quantities over contract term may vary. 16755 Von Karman Ave. Suite 150, Irvine, CA 92606 4 949,474 2330 1 adam e-siteeier.com AS ADAMS STREETER ADAMS STREETER CIVIL ENGINEERS 2021 PROFESSIONAL FEE SCHEDULE CIVIL ENGINEERING SERVICES Principal Project Director ..................................... Project Manager ................................... Project Engineer ................................... CADD Designer / Technician .......... Clerical / Word Processing .............. SURVEYING AND MAPPING SERVICES 2-Man Survey Crew (Field) *...------ ................................................ .......... .... ....... ....... ....... _.......... $250.00/hour 1-Man Survey Crew (Field)*.......................................................................................................... $215.00/hour SurveyOffice / Mapper..................................................._..............................-............................. $150.00/hour * Prevailing Wage Rates. REIMBURSABLE EXPENSES All out of pocket expenses, such as filing and plan check fees, permit fees, delivery service, reproduction printing, and other project expenses will be extra and invoiced at our direct cost. MILEAGE Mileage will be invoiced at the IRS standard mileage rate for 2021. * Rate applied for plan checking services. H755 Vcn Kaman Ave. Su,te 150. :rvme -A 312 OM. 94o 47i ?31n aJan+s-stfee,e, c NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Adams Streeter Civil Engineers, Inc. Name: Project A-2021-085; PO 6925 Number: Project Agreement To Provide On-Call Development Plan Checking Name: Services For Water Resources Division 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 AUTOMOBILE LIABILITY PSA0001063 09/01/2023 08/18/2022 Certificate.pdf GENERAL LIABILITY PSB0001237 09/01/2023 08/18/2022 Certificate.pdf PROFESSIONAL LIABILITY V21EE9220501 02/13/2023 08/18/2022 Certificate.pdf WORKERS COMPENSATION AND PSW0001554 09/01/2023 08/18/2022 Certificate.pdf EMPLOYERS' LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 11/1/2022 1:47 PM NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Adams Streeter Civil Engineers, Inc. Name: Project A-2021-085; PO 6925 Number: Project Agreement To Provide On-Call Development Plan Checking Services For Name: Water Resources Division 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 AUTOMOBILE LIABILITY PSA0001063 09/01/2023 08/18/2022 Certificate.pdf GENERAL LIABILITY PSB0001237 09/01/2023 08/18/2022 Certificate.pdf PROFESSIONAL LIABILITY V21EE9230601 02/13/2024 02/03/2023 Certificate.pdf WORKERS COMPENSATION AND PSW0001554 09/01/2023 08/18/2022 Certificate.pdf EMPLOYERS' LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 2/6/2023 1:42 PM DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 8/14/2024 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 CONTACT NAME: Danl Schulze AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX 3697 Mt. Diablo Blvd Suite 230 A/C No EXt: 714-202-0390 A/c,No): Lafayette CA 94549 ADDRESS: CertsDesignPro@AssuredPartners.com INSURER(S)AFFORDING COVERAGE NAIC# License#:6003745 INSURERA:Aspen Specialty Insurance Company 10717 INSURED PROAENG-01 INSURER B: Citizens Insurance Company of America 31534 Proactive Engineering Consultants 200 S. Main Street, Suite 300 INSURERC:Allmerica Financial Benefit Insurance Company 41840 Corona CA 92882 INSURERD: Hartford Casualty Insurance Company 29424 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1132971798 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY B X COMMERCIAL GENERAL LIABILITY Y Y OBFJ100553 8/7/2024 8/7/2025 EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea or $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PRO- POLICY� ECT1:1 LOC PRODUCTS-COMP/OPAGG $4,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y Y AWFJ100189 8/7/2024 8/7/2025 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLALIAB X OCCUR Y Y OBFJ100553 8/7/2024 8/7/2025 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$n $ D WORKERS COMPENSATION Y 57WEGBH5UCM 8/7/2024 8/7/2025 X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 ❑ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liability AAAE300254-04 8/7/2024 8/7/2025 Per Claim $2,000,000 Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Umbrella Policy is follow form to its underlying Policies:General Liability/Auto Liability/Employers Liability. Re:All Operations of the Named Insured. The City of Santa Ana, its officers,officials,employees and volunteers are named as an additional insured as respects general liability as required per written contract. General Liability is Primary/Non-Contributory per policy form wording. APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS Policy Number: 51WEGBH5UCM Endorsement Number: Effective Date: 0 810 7/2 024 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Proactive Engineering 200 S.Main Street,Suite Corona CA 92882 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: INDEX SUBJECT PAGE SUBJECT PAGE SECTION 1 2 B. Part One Does Not Apply 3 PARTS ONE and TWO 2 C. Application of Coverage 3 01 We Will Also Pay 2 D. Additional Exclusions 3 PART-THREE 2 E. West Virginia 3 02 How This Insurance Works 2 EXTENDED OPTIONS 4 PART-SIX 2 01 Employers' Liability Insurance 4 03 Transfer of Your Rights and Duties 2 02 Unintentional Failure to Disclose 4 04 Cancellation 2 Hazards 05 Liberalization 2 03 Waiver of Our Right to Recover from 4 SECTION II 2 Others VOLUNTARY COMPENSATION INSURANCE 2 04 Foreign Voluntary Compensation 4 06 Voluntary Compensation Insurance A. How This Reimbursement Applies 4 A. How This Insurance Applies 2 B. We Will Reimburse 4 B. We Will Pay 2 C. Exclusions 4 C. Exclusions 3 D. Before We Pay 5 D. Before We Pay 3 E. Recovery From Others 5 E. Recovery From Others 3 F. Reimbursement For Actual Loss 5 F. Employers' Liability Insurance 3 Sustained EMPLOYERS' LIABILITY STOP GAP 3 G. Repatriation 5 ENDORSEMENT 3 H. Endemic Disease 5 07 Employers' Liability Stop Gap 05 Longshore and Harbor Workers' 5 Coverage 3 Compensation Act Coverage A. Stop Gap Coverage Limited to Endorsement Montana, North Dakota, Ohio, 3 SECTION III 6 Washington, West Virginia and 0 APPROVED Wyoming By Cynthia Mora at 11:34 am, Dec 05, 2024 F o r m W C 9 9 0 3 0 1 B Printed in U.S.A. (Ed. 8/00) Page 1 of 6 Process Date: Policy Expiration Date: © 2000, The Hartford SECTION I PARTS ONE and TWO the Information Page, coverage will not be 1. WE WILL ALSO PAY afforded for that state unless we are notified D. We Will Also Pay of Part One (WORKERS' within sixty days. COMPENSATION INSURANCE); and PART SIX E. We Will Also Pay of Part Two (EMPLOYERS' LIABILITY INSURANCE) is replaced by the 3. Transfer Of Your Rights and Duties following: C. Transfer Of Your Rights and Duties of Part 6 We Will Also Pay (Conditions) is replaced by the following: We will also pay these costs, in addition to Your rights or duties under this policy may not other amounts payable under this insurance, be transferred without our written consent. as part of any claim, proceeding, or suit we If you die and we receive notice within sixty defend: days after your death, we will cover your legal 1. reasonable expenses incurred at our representative as insured. request, INCLUDING loss of earnings; 4. Cancellation 2. premiums for bonds to release Paragraph 2. of D. Cancellation of Part 6 attachments and for appeal bonds in bond (Conditions) is replaced by the following: amounts up to the limit of our liability 2. We may cancel this policy. We must mail or under this insurance; deliver to you not less than 15 days advance 3. litigation costs taxed against you; written notice stating when the cancellation is 4. interest on a judgment as required by law to take effect. Mailing that notice to you at until we offer the amount due under this your mailing address shown in Item 1 of the law; and Information Page will be sufficient to prove notice. 5. expenses we incur. 5. Liberalization PART THREE If we adopt a change in this form that would broaden the coverage of this form without extra 2. How This Insurance Applies charge, the broader coverage will apply to this Paragraph 4. of A. How This Insurance Applies policy. It will apply when the change becomes of Part 3 (Other States Insurance) is replaced by effective in your state. the following: 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of SECTION II VOLUNTARY COMPENSATION AND EMPLOYERS' 2. The bodily injury must arise out of and in LIABILITY COVERAGE the course of employment or incidental to 6. Voluntary Compensation Insurance work in a state shown in Item 3.A. of the Information Page. A. How This Insurance Applies 3. The bodily injury must occur in the United This insurance applies to bodily injury by States of America, its territories or accident or bodily injury by disease. Bodily possessions, or Canada, and may occur injury includes resulting death. elsewhere if the employee is a United 1. The bodily injury must be sustained by any States or Canadian citizen, or otherwise officer or employee not subject to the legal resident, and legally employed, in the workers' compensation law of any state United States or Canada and temporarily shown in Item 3.A. of the Information away from those places. Page. APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) Page 2 of 6 4. Bodily injury by accident must occur keep an amount equal to our expenses of during the policy period. recovery and the benefits we paid. We will 5. Bodily injury by disease must be caused pay the balance to the persons entitled to it. If or aggravated by the conditions of the the persons entitled to the benefits of this officer's or employee's employment. The insurance make a recovery from others, they officer's or employee's last day of last must reimburse us for the benefits we paid exposure to the conditions causing or them. aggravating such bodily injury by disease F. Employers' Liability Insurance must occur during the policy period. Part Two (Employers' Liability Insurance) B. We Will Pay applies to bodily injury covered by this We will pay an amount equal to the benefits endorsement as though the State of that would be required of you as if you and Employment was shown in Item 3.A. of the your employees were subject to the workers' Information Page. compensation law of any state shown in Item This provision 6. does not apply in New Jersey or 3.A. of the Information Page. We will pay Wisconsin. those amounts to the persons who would be EMPLOYERS' LIABILITY STOP GAP COVERAGE entitled to them under the law. C. Exclusion 7. Employers' Liability Stop Gap Coverage A. This coverage only applies in Montana, North This insurance does not cover: Dakota, Ohio, Washington, West Virginia and 1. any obligation imposed by workers' Wyoming. compensation or occupational disease law B. Part One (Workers' Compensation Insurance) or any similar law. does not apply to work in states shown in 2. bodily injury intentionally caused or Paragraph A above. aggravated by you. C. Part Two (Employers' Liability Insurance) 3. officers or employees who have elected applies in the states, shown in Paragraph A., not to be subject to the state workers' as though they were shown in Item 3.A. of the compensation law. Information Page. 4. partners or sole proprietors not covered D. Part Two, Section C. Exclusions is changed under the Standard Sole Proprietors, by adding these exclusions. Partners, Officers and Others Coverage This insurance does not cover; Endorsement. 5. bodily injury intentionally caused or D. Before We Pay aggravated by you or in Ohio bodily injury Before we pay benefits to the persons entitled resulting from an act which is determined to them, they must: by an Ohio court of law to have been 1. Release you and us, in writing, of all committed by you with the belief than an responsibility for the injury or death. injury is substantially certain to occur. 2. Transfer to us their right to recover from However, the cost of defending such others who may be responsible for the claims or suits in Ohio is covered. injury or death. 13. bodily injury sustained by any member of 3. Cooperate with us and do everything the flying crew of any aircraft. necessary to enable us to enforce the right 14. any claim for bodily injury with respect to to recover from others. which you are deprived of any defense or defenses or are otherwise subject to If the persons entitled to the benefits of this penalty because of default in premium insurance fail to do those things, our duty to under the provisions of the workers' pay ends at once. If they claim damages from compensation law or laws of a state you or from us for the injury or death, our duty to pay ends at once. shown in Paragraph A. E. This insurance applies to damages for which E. Recovery From Others you are liable under West Virginia Code Annot. If we make a recovery from others, we will S 23-4-2. APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) Page 3 of 6 EXTENDED OPTIONS 1. Employers' Liability Insurance 4. Foreign Voluntary Compensation and Item 3.13. of the Information Page is replaced by Employers' Liability Reimbursement the following: A. How This Reimbursement Applies B. Employers' Liability Insurance: This reimbursement provision applies to bodily 1. Part Two of the policy applies to work in injury by accident or bodily injury by disease. each state listed in Item 3.A. Bodily injury includes resulting death. 1. The bodily injury must be sustained by an The Limits of Liability under Part Two are officer or employee. the higher of: 2. The bodily injury must occur in the course of employment necessary or incidental to Bodily Injury work in a country not listed in Exclusion by Accident $500,000 Each Accident C.I. of this provision. 3. Bodily injury by accident must occur Bodily Injury during the policy period. by Disease $500,000 Policy Limit 4. Bodily injury by disease must be caused or aggravated by the conditions of your Bodily Injury employment. The officer or employee's by Disease $500,000 Each Employee last exposure to those conditions of your employment must occur during the policy OR period. B. We Will Reimburse 2. The amount shown in the Information We will reimburse you for all amounts paid by Page. you whether such amounts are: This provision 1 of EXTENDED OPTIONS does not 1. voluntary payments for the benefits that apply in New York because the Limits Of Our would be required of you if you and your Liability are unlimited. officers or employees were subject to any In this provision the limits are changed from workers' compensation law of the state of $500,000 to $1,000,000 in California. hire of the individual employee. 2. Unintentional Failure to Disclose Hazards 2. sums to which Part Two (Employers' If you unintentionally should fail to disclose all Liability Insurance) would apply if the existing hazards at the inception date of your Country of Employment were shown in policy, we shall not deny coverage under this Item 3.A. of the Information Page. policy because of such failure. C. Exclusions 3. Waiver of Our Right To Recover From Others This insurance does not cover: A. We have the right to recover our payments 1. any occurrences in the United States, from anyone liable for an injury covered by this Canada, and any country or jurisdiction policy. We will not enforce our right against which is the subject of trade or economic any person or organization for whom you sanctions imposed by the laws or perform work under a written contract that regulations of the United States of requires you to obtain this agreement from us. America in effect as of the inception date This agreement shall not operate directly or of this policy. indirectly to benefit anyone not named in the 2. any obligation imposed by a workers' agreement. compensation or occupational disease B. This provision 3. does not apply in the states law, or similar law. of Pennsylvania and Utah. 3. bodily injury intentionally caused or noorayntpd by you- APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) Page 4 of 6 4. liability for any consequence, whether of America necessarily incurred as a direct direct or indirect, of war, invasion, act of result of bodily injury. Foreign enemy, hostilities (whether war be Our reimbursement shall be limited as follows: declared or not), civil war, rebellion, revolution, insurrection or military or 1. to the amount by which such expenses usurped power. No endorsement now or exceed the normal cost of returning the subsequently attached to this policy shall officer or employee if in good health, or be construed as overriding or waiving this 2. in the event of death, to the amount by limitation unless specific reference is which such expenses exceed the normal made thereto. cost of returning the officer or employee if D. Before We Pay alive and in good health. Before we reimburse you for the benefits to the In no event shall our reimbursement exceed persons entitled to them, you must have them: the bodily injury by accident limit shown in Item 3.B. of the Information Page as respects 1. release you and us, in writing, of all any one such officer or employee whether responsibility for the injury or death, dead or alive. 2. transfer to us their right to recover from H. Endemic Disease others who may be responsible for their injury or death, The word "disease" includes any endemic diseases. 3. cooperate with us and do everything necessary to enable us to enforce the right The coverage applies as if endemic diseases were included in the provisions of the workers' to recover from others. If the persons entitled to the benefits paid fail compensation law. to do these things, our duty to reimburse ends 5. Longshore and Harbor Workers' Compensation at once. If they claim damages from us for the Act Coverage injury or death, our duty to reimburse ends at General Section C. Workers' Compensation once. Law is replaced by the following: E. Recovery From Others C. Workers'Compensation Law If we make a recovery from others, we will Workers' Compensation Law means the keep an amount equal to our expenses of workers or workers' compensation law and recovery and the benefits we reimbursed. We occupational disease law of each state or will pay the balance to the persons entitled to territory named in Item 3.A. of the Information it. If persons entitled to the benefits make a Page and the Longshore and Harbor Workers' recovery from others, they must repay us for Compensation Act (33 USC Sections 901- the amounts that we have reimbursed you. 950). It includes any amendments to those F. Reimbursement for Actual Loss Sustained laws that are in effect during the policy period. This endorsement provides only for It does not include any other federal workers reimbursement for the loss you actually or workers' compensation law, other federal occupational disease law or the provisions of sustain. In order for you to recover loss or any law that provide nonoccupational disability expenses under this reimbursement you must: benefits. 1. actually sustain and pay the loss or Part Two (Employers' Liability Insurance), C. expense in money after trial, or Exclusions, exclusion 8, does not apply to 2. secure our consent for the payment of the work subject to the Longshore and Harbor loss or expense. Workers' Compensation Act. G. Repatriation This coverage does not apply to work subject Our reimbursement includes the additional to the Defense Base Act, the Outer expenses of repatriation to the United States Continental Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) Page 5 of 6 SECTION III 1. SCHEDULE OF COVERED STATES B. If a state, shown in Item 3.A. of the Information A. This endorsement only applies in the states Page, approves this endorsement after the listed in this Schedule of Covered States. effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval. C. Schedule of Covered States: APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Countersigned by Authorized Representative Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) Page 6 of 6 Policy#AWFJ100189 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART A. The following is added to SECTION II - Primary and Non-Contributory LIABILITY COVERAGE, Paragraph A.1. Who Is If you agree in a written contract, written An Insured: agreement or written permit that the insurance Additional Insured if Required by Contract provided to a person or organization who If you agree in a written contract, written qualifies as an additional "insured" under agreement or written permit that a person or SECTION II - LIABILITY COVERAGE, Paragraph organization be added as an additional A.I. Who Is An Insured, subparagraph "insured" under this Coverage Part, such Additional Insured if Required by Contract Is person or organization is an "insured"; but only primary and non-contributory, the following to the extent that such person or organization applies: qualifies as an "insured" under paragraph A.1.c. The liability coverage provided by this Coverage of this Section. Part is primary to any other insurance available If you agree in a written contract, written to the additional "insured" as a Named Insured. agreement or written permit that a person or We will not seek contribution from any other organization be added as an additional insurance available to the additional insured "insured" under this Coverage Part, the most except: we will pay on behalf of such additional (1) For the sole negligence of the additional "insured" is the lesser of: "insured"; or (1) The Limits of Insurance for liability coverage (2) For negligence arising out of the ownership, specified in the written contract, written maintenance or use of any "auto" not owned agreement or written permit; or by the additional "insured" or by you, unless (2) The Limits of Insurance for Liability that "auto" is a "trailer" connected to an Coverage shown in the Declarations "auto" owned by the additional "insured" or applicable to this Coverage Part. by you; or Such amount shall be part of and not in addition (3) When the additional "insured" is also an to the Limits of Insurance shown in the additional insured under another liability Declarations applicable to this Coverage Part. policy. Regardless of the number of covered "autos", C. This endorsement will apply only if the "insureds", premiums paid, claims made or "accident" occurs: vehicles involved in the "accident", the most we 1. During the policy period; will pay for the total of all damages and covered pollution cost or expense combined 2• Subsequent to the execution of the written resulting from any one "accident" is the Limit of contract or written agreement or the Insurance for Liability Coverage shown in the issuance of the written permit; and Declarations. 3. Prior to the expiration of the period of time B. The following is added to SECTION IV - that the written contract, written agreement BUSINESS AUTO CONDITIONS, Paragraph B. or written permit requires such insurance to General Conditions, subparagraph 5. Other be provided to the additional "insured". Insurance: D. Coverage provided to an additional "insured" will not be broader than coverage provided to any other"insured" under this Coverage Part. ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED. APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 461-0478 12 12 Includes copyrighted material of ISO Insurance Services Office, Inc.,with its permission Page 1 of 1 Hanover Insurance Group- AWFJ100189 5701807 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. CANCELLATION EXTENSION d. Any business entity for which you Paragraph A. CANCELLATION 2. b. of the have a financial interest greater COMMON POLICY CONDITIONS is than 50% of the voting stock or replaced with the following: otherwise have a controlling b. 60 days before the effective date interest after the effective date of of cancellation if we cancel for this policy or that is newly any other reason. acquired or formed by you during the term of this policy. SECTION I - COVERED AUTOS The coverage provided by this 2. EMPLOYEE HIRED "AUTOS" provision is afforded until Description Of Covered Auto expiration or termination of Designation Symbols; Symbol 8 is this policy, whichever occurs replaced by the following: earlier. 8 = Hired "Autos" Only - Only those The coverage provided by this "autos" you lease, hire, rent or borrow; provision does not apply to including "autos" your employee hires at any business entity described your direction, for the purpose of in d. above that qualifies as an conducting your business. This does not insured under any other include any "auto" you lease, hire, rent, or automobile liability policy borrow from any of your "employees" or issued to that business entity partners or members of their households. as a named insured or would have been an insured except SECTION II - LIABILITY COVERAGE for the exhaustion of the policy limits or the insolvency 3. BROADENED NAMED INSURED of the insurer. The following is added to the SECTION II - The coverage provided by this LIABILITY COVERAGE, Paragraph 1. Who provision does not apply to Is An Insured provision: "bodily injury" nor "property damage" arising from an accident that occurred prior to your acquiring or forming the APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Includes copyrighted material of Insurance Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 1 of 7 4. EMPLOYEES AS INSUREDS SECTION III - PHYSICAL DAMAGE COVERAGE. The following is added to the SECTION II - LIABILITY COVERAGE, Paragraph 1. Who 7. EXPENSE OF RETURNING A STOLEN Is An Insured provision: "AUTO" and SIGN COVERAGE e. Any employee of yours is an The following is added to SECTION III - "insured" while using a covered PHYSICAL DAMAGE COVERAGE, A.1. "auto" you do not own, hire or COVERAGE: borrow in your business or your personal affairs. d. Expense Of Returning A Stolen "Auto" 5. SUPPLEMENTARY PAYMENTS The following amends SECTION II - We will pay for the expense of LIABILITY COVERAGE, Paragraph 2. returning a covered "auto" to you. Coverage Extensions provision: e. Sign Coverage Paragraph (2) is replaced by the following: We will pay for loss to signs, (2) Up to $2500 for cost of bail bonds murals, paintings or graphics, (including bonds for related traffic as part of equipment, which are law violations) required because displayed on a covered "auto". of an "accident" we cover. We do not have to furnish these bonds. The most we will pay for "loss" in Paragraph (4) is replaced by the following: any one "accident" is the lesser of: (4) All reasonable expenses incurred by the "insured" at our request, 1. The actual cash value of including actual loss of earnings the property as of the up to $500 a day because of time time of the 'loss"; or off from work. 2. The cost of repairing or 6. AMENDED FELLOW EMPLOYEE replacing the damaged or EXCLUSION stolen property with other property of like kind and y; or The following is added to the SECTION II - 3. quality; $2,000. LIABILITY COVERAGE, B. Exclusions Paragraph 5. Fellow Employee exclusion: g. GLASS BREAKAGE DEDUCTIBLE This exclusion does not apply if the The following is added to SECTION III - "bodily injury" arises from the use of a PHYSICAL DAMAGE COVERAGE, A. covered "auto" you own or hire. This COVERAGE paragraph 3. Glass Breakage - coverage is excess over any other Hitting a Bird or Animal - Falling Objects collectible insurance or Missiles: Any deductible shown in the Declarations as applicable to the APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Includes copyrighted material of Insurance Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 2 of 7 Hanover Insurance 0-011p.. AWFJ100189 5701807 covered "auto" will not apply to glass direction, for the purpose of breakage if such glass is repaired, conducting your business, for a rather than replaced. period of 30 days or less, of like kind and use as the "autos" you 9. TRANSPORTATION EXPENSE own, subject to the following: Paragraph 4. Coverage Extension. of The most we will pay for any one SECTION III - PHYSICAL DAMAGE loss is the lesser of the following: COVERAGE, A. COVERAGE is replaced with the following: a. $50,000 per accident, or b. cash value, or 4. Coverage Extension c. the cost of repair, We will pay up to $50 per day to a minus the deductible equal to the maximum of$1500 for temporary lowest deductible applicable to transportation expense incurred any owned "auto" for that by you because of the total theft of coverage. Any deductible shown a covered "auto" of the private in the Declarations does not apply passenger type. We will pay only to "loss" caused by fire or for those covered "autos" for lightning. Subject to the limit and which you carry either deductible stated above, we will Comprehensive or Specified provide coverage equal to the Causes of Loss Coverage. We will broadest coverage provided to pay for temporary transportation any covered "auto" you own, that expenses incurred during the is applicable to the loss. period beginning 24 hours after the theft and ending, regardless of If the loss arises from an accident the policy s expiration, when the for which you are legally liable covered "auto" is returned to use and the lessor incurs an actual or we pay for its "loss". financial loss from that accident, we will cover the lessor s actual 10. HIRED AUTO PHYSICAL DAMAGE financial loss of use of the hired "auto" for a period of up to seven The following is added to SECTION III - consecutive days from the date of PHYSICAL DAMAGE COVERAGE, A. the accident, subject to a limit of COVERAGE: $1,000 per accident. 5. Hired Auto Physical Damage 11. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE If hired "autos" are covered "autos" for Liability Coverage and The following is added to SECTION III - if Physical Damage Coverage of PHYSICAL DAMAGE COVERAGE, A. Comprehensive, Specified Causes COVERAGE: of Loss, or Collision is provided under this Coverage Form for any 6. Audio, Visual and Data Electronic "auto" you own, then the Physical Equipment Coverage Damage Coverage(s) provided is extended to "autos" you hire We will pay for 'loss" to an without a driver or your employee APPROVED hires, without a driver, at your By Cynthia Mora at 11:34 am, Dec 05, 2024 Includes copyrighted material of Insurance . Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 3 of 7 or transmits audio, visual or data equipment is permanently signals and that is not designed installed in the covered solely for the reproduction of "auto", and sound. This coverage applies b. Permanently installed only if the equipment is in the opening of the dash permanently installed in the or console normally used covered "auto" at the time of the by the manufacturer for "loss" or the equipment is the installation of a radio. removable from a housing unit which is permanently installed in With respect to coverage herein, the covered auto at the time of the LIMIT OF INSURANCE the "loss", and such equipment is provision of PHYSICAL DAMAGE designed to be solely operated by COVERAGE is replaced by the use of the power from the "auto s" following: electrical system, in or upon the covered "auto", including its 1. The most we will pay for all antennas and other accessories. "loss" to audio, visual or data However , this does not include electronic equipment and any tapes, records or discs. accessories used with this equipment as a result of any The exclusions that apply to one "accident" is the lesser of PHYSICAL DAMAGE COVERAGE, except for the exclusion relating to a. The actual cash value of Audio, Visual and Data Electronic the damaged or stolen Equipment, also apply to coverage property as of the time of provided herein. In addition, the the 'loss"; or following exclusions apply: b. The cost of repairing or replacing the damaged or We will not pay , under this stolen property with other coverage, for either any electronic property of like kind and equipment or accessories used quality; or with such electronic equipment c. $500. that is: 2. An adjustment for 1. Necessary for the normal depreciation and physical operation of the covered condition will be made in "auto" or the monitoring of determining actual cash value the covered "auto s" at the time of the "loss". operating system; or 3. Deductibles applicable to 2. Both: PHYSICAL DAMAGE COVERAGE, do not apply a. An integral part of the to this Audio, Visual and Data same unit housing any Electronic Equipment sound reproducing Coverage. equipment designed solely for the If there is other coverage provided reproduction of sound if by this policy for audio, visual and the sound reproducing APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Includes copyrighted material of Insurance Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 4 of 7 Hanover Insurance Group.. AWFJ100189 5701807 excess. However, you may elect cove red"auto". If loss is to apply the limit or any portion caused by theft, this thereof of coverage provided number of days is added herein to pay any deductible that to the number of days it is applicable under the provisions takes to locate the covered of the other coverage. "auto" and transport it to a repair shop. 12. RENTAL REIMBURSEMENT and MATERIAL TRANSFER EXPENSE 2. 60 days. The following is added to SECTION III - Our payment is limited to the PHYSICAL DAMAGE COVERAGE, A. lesser of the following amounts: COVERAGE: 1. Necessary and actual 7. Rental Reimbursement and expenses incurred, Material Transfer Expense including loss of use. This coverage provides only those 2. $3000. Physical Damage Coverages where a premium is shown in the This auto rental expense coverage Declarations. It applies only to a does not apply while there are covered "auto" described or spare or reserve "autos" available designated to which the Physical to you for your operations. Damage Coverages apply. If"loss" results from the total theft We will pay for auto rental of a covered "auto" of the private expenses and the expenses, passenger type, we will pay under incurred by you because of"loss" this coverage only that amount of to a covered "auto", to remove your rental reimbursement and transfer your materials and expenses which is not already equipment from the covered provided for under the SECTION "auto" . Payment applies in III - PHYSICAL DAMAGE addition to the otherwise COVERAGE, A. 4. Coverage applicable amount of each Extension. coverage you have on a covered "auto". No deductibles apply to 13. AIRBAG COVERAGE this coverage. The following is added to SECTION III - We will pay only for those auto PHYSICAL DAMAGE COVERAGE, B. rental expenses incurred during Exclusions, paragraph 3. the policy period beginning 24 hours after the "loss" and ending, The portion of this exclusion relating to regardless of the policy s mechanical or electrical breakdown does expiration, with the lesser of the not apply to the accidental discharge of an following number of days: airbag. This coverage is excess of other collectible insurance or warranty. No 1. The number of days deductible applies to this Airbag reasonably required to Coverage. repair or replace the APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Includes copyrighted material of Insurance . Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 5 of 7 14. AUTO LOAN PHYSICAL DAMAGE imposed under a lease for excessive use, EXTENSION abnormal wear and tear or high mileage; security deposits not refunded by the The following is added to SECTION III - lessor; cost for extended warranties, PHYSICAL DAMAGE COVERAGE, C. Limit Credit Life Insurance, Health, Accident or Of Insurance provision: Disability Insurance purchased with the loan; and carry over balances from When a 'loss" results in a total loss to a previous leases. covered auto you own for which a Loss Payee is designated in this policy, the This coverage applies only to the initial most we will pay for "loss" in any one lease for the covered "auto" which has not "accident" is the greater of: previously been leased. This coverage is excess over all other collectible 1. The actual cash value of the insurance. damaged or stolen property as of the time of the "loss"; or SECTION IV - CONDITIONS 2. The outstanding balance of the 16. DUTIES IN THE EVENT OF ACCIDENT, initial loan, less any amounts for CLAIM, SUIT OR LOSS taxes, overdue payments, overdue payment charges, penalties, The following is added to SECTION IV - interest , any charges for early BUSINESS AUTO CONDITIONS, A. Loss termination of the loan, costs for Conditions, 2. Duties In The Event Of Credit Life Insurance, Health, Accident, Claim, Suit Or Loss: Accident or Disability Insurance purchased with the loan, and d. Knowledge of any "accident", carry-over balances from previous claim, "suit" or 'loss" will be loans. deemed knowledge by you when notice of such "accident", 15. AUTO LEASE PHYSICAL DAMAGE claim, "suit" or 'loss" has been EXTENSION received by: The following is added to SECTION III - (1) You, if you are an individual; PHYSICAL DAMAGE COVERAGE, C. Limit (2) Any partner or insurance Of Insurance provision: manager if you are a partnership; or If, because of damage, destruction or theft (3) An executive officer or of a covered "auto", which is a long-term insurance manager if you are leased "auto", the lease agreement a corporation. between you and the lessor is terminated, "we" will pay the difference between the 17. BLANKET WAIVER OF SUBROGATION amount paid under paragraph C. LIMIT OF INSURANCE 1. or 2. and the amount due Paragraph 5. Transfer Of Rights Of at the time of"loss" under the terms of Recovery Against Others To Us, SECTION the lease agreement applicable to the IV - BUSINESS AUTO CONDITIONS, A. leased "auto" which you are required to Loss Conditions is replaced by the pay: less any fees to dispose of the auto; following: any overdue payments; financial penalties APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Includes copyrighted material of Insurance . Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 6 of 7 Hanover Insurance Group.. AWFJ100189 5701807 5. Transfer Of Rights Of Recovery 19. HIRED AUTO -WORLDWIDE Against Others To Us COVERAGE If any person or organization to or The following is added to SECTION IV - for whom we make payment Business Auto Conditions, B. General under this Coverage Form has Conditions, paragraph 7. Policy Period, rights to recover damages from Coverage Territory provision: another, which have not been waived through the execution of e. Outside the coverage territory an "insured contract", written described in a., b., c., and d. agreement, or permit, prior to the above for an "accident" or 'loss" "accident" or "loss" giving rise to resulting from the use of a the payment, those rights to covered "auto" you hire, without a recover damages from another driver, or your employee hires are transferred to us. That person without a driver, at your direction, or organization must do for the purpose of conducting your everything necessary to secure business, for a period of 30 days our rights and must do nothing or less, provided the suit is after the "accident" or "loss" to brought within The United States impair them. of America or its territories or possessions. 18. UNINTENTIONAL FAILURE TO DISCLOSE INFORMATION SECTION V- DEFINITIONS The following is added to SECTION IV 20. MENTAL ANGUISH BUSINESS AUTO CONDITIONS. B. General Conditions, paragraph 2. Paragraph C. 'Bodily injury", SECTION V- Concealment, Misrepresentation Or Fraud: DEFINITIONS is replaced by the following: Your unintentional error in disclosing, C. "Bodily injury" means bodily injury, or failure to disclose, any material fact sickness or disease sustained by a existing after the effective date of this person including death or mental Coverage Form shall not prejudice anguish resulting from any of these. your rights under this Coverage Form. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal. APPROVED By Cynthia Mora at 11:34 am, Dec 05, 2024 Includes copyrighted material of Insurance . Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 7 of 7 Policy# OBFJ100553 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES Limits Page 1. Additional Insured by Contract, Agreement or Permit Included 1 2. Additional Insured - Broad Form Vendors Included 2 3. Alienated Premises Included 3 4. Broad Form Property Damage - Borrowed Equipment, Customers Included 3 Goods and Use of Elevators 5. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) Included 3 6. Personal and Advertising Injury - Broad Form Included 4 7. Product Recall Expense Included 4 Product Recall Expense Each Occurrence Limit $25,000 5 Occurrence Product Recall Expense Aggregate Limit $50,000 5 Aggregate Product Recall Deductible $500 5 8. Unintentional Failure to Disclose Hazards Included 6 9. Unintentional Failure to Notify Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II - (2) Premises you own, rent, lease or LIABILITY: occupy; or 1. Additional Insured by Contract, Agreement or (3) Your maintenance, operation or use of Permit equipment leased to you. The following is added to SECTION II - b. The insurance afforded to such additional LIABILITY, C.Who Is An Insured: insured described above: Additional Insured by Contract, Agreement or (1) Only applies to the extent permitted by Permit law; and a. Any person or organization with whom you (2) Will not be broader than the insurance agreed in a written contract, written which you are required by the contract, agreement or permit to add such person or agreement or permit to provide for such organization as an additional insured on additional insured. your policy is an additional insured only with (3) Applies on a primary basis if that is respect to liability for bodily injury , required by the written contract, written "property damage", or "personal and agreement or permit. advertising injury' caused, in whole or in part, by your acts or omissions, or the acts (4) Will not be broader than coverage or omissions of those acting on your behalf, provided to any other insured. but only with respect to: (5) Does not apply if the "bodily injury", (1) "Your work" for the additional insured(s) "property damage" or "personal and designated in the contract, agreement or advertising injury"is otherwise excluded permit; from coverage under this Coverage Part, including any endorsements thereto. 391-1006 08 16 Includes copyrighted materials of In APPROVED gel of 6 By Cynthia Mora at 11:35 am, Dec 05, 2024 Hanover Insurance Group- OBFJ100553 5701807 c. This provision does not apply: The most we will pay on behalf of the (1) Unless the written contract or written additional insured for a covered claim is the agreement was executed or permit was lesser of the amount of insurance: issued prior to the "bodily injury", 1. Required by the contract, agreement or "property damage", or "personal injury permit described in Paragraph a.; or and advertising injury". 2. Available under the applicable Limits of (2) To any person or organization included Insurance shown in the Declarations. as an insured by another endorsement This endorsement shall not increase the issued by us and made part of this applicable Limits of Insurance shown in the Coverage Part. Declarations (3) To any lessor of equipment: e. All other insuring agreements, exclusions, (a) After the equipment lease expires; or and conditions of the policy apply. (b) If the "bodily injury", "property 2. Additional Insured - Broad Form Vendors damage", "personal and advertising The following is added to SECTION II - injury" arises out of sole negligence LIABILITY, C.Who Is An Insured: of the lessor. (4) To any: Additional Insured - Broad Form Vendors a Owners or other interests from whom a. Any person or organization that is a vendor ( ) with whom you agreed in a written contract land has been leased if the "occurrence" takes place or the or written agreement to include as an offense is committed after the lease additional insured under this Coverage Part is an insured, but only with respect to liability for the land expires; or for "bodily injury" or "property damage" (b) Managers or lessors of premises if: arising out of "your products" which are (i) The "occurrence" takes place or distributed or sold in the regular course of the offense is committed after the vendors business. you cease to be a tenant in that b. The insurance afforded to such vendor premises; or described above: (ii) The "bodily injury", "property (1) Only applies to the extent permitted by damage", "personal injury" or law; "advertising injury" arises out of (2) Will not be broader than the insurance structural alterations, new which you are required by the contract or construction or demolition agreement to provide for such vendor; operations performed by or on behalf of the manager or lessor. (3) Will not be broader than coverage 5 To "bodilyinjury", "property dams e" or provided to any other insured; and ( ) r g 4 Does not apply if the "bodily injury", "personal and advertising injury" arising ( ) pp Y Y out of the rendering of or the failure to "property damage" or "personal and render any professional services. advertising injury" is otherwise excluded from coverage under this Coverage Part, This exclusion applies even if the claims including any endorsements thereto against any insured allege negligence or other wrongdoing in the supervision, c. With respect to insurance afforded to such hiring, employment, training or vendors, the following additional exclusions monitoring of others by that insured, if apply: the "occurrence" which caused the The insurance afforded to the vendor does "bodily injury" or "property damage" or not apply to: the offense which caused the "personal ( ) y 1 "Bodily injury" or "property damage" for and advertising injury involved the which the vndor is obliated to pay rendering of or failure to render any damages by reasons of the assumption of professional services by or for you. liability in a contract or agreement. This d. With respect to the insurance afforded to exclusion does not apply to liability for these additional insureds, the following is damages that the insured would have in added to SECTION II - LIABILITY, D. Liability the absence of the contract or and Medical Expense Limits of Insurance: agreement; (2) Any express warranty unauthorized by you; APPROVED 391-1006 08 16 Includes copyrighted materials of In By Cynthia Mora at 11:35 am, Dec 05, 2024 e 2 of 6 (3) Any physical or chemical change in the The most we will pay on behalf of the vendor product made intentionally by the for a covered claim is the lesser of the vendor; amount of insurance: (4) Repackaging, unless unpacked solely for 1. Required by the contract or agreement the purpose of inspection, described in Paragraph a.; or demonstration, testing, or the 2. Available under the applicable Limits of substitution of parts under instruction Insurance shown in the Declarations; from the manufacturer, and then repackaged in the original container; This endorsement shall not increase the (5) Any failure to make such inspection, applicable Limits of Insurance shown in the adjustments, tests or servicing as the Declarations. vendor has agreed to make or normally 3. Alienated Premises undertakes to make in the usual course SECTION II - LIABILITY, B. Exclusions, 1. of business in connection with the sale Applicable To Business Liability Coverage k. of the product; Damage to Property, paragraph (2) is replaced by (6) Demonstration, installation, servicing or the following: repair operations, except such (2) Premises you sell, give away or abandon, if operations performed at the vendor's the "property damage" arises out of any part premises in connection with the sale of of those premises and occurred from hazards the product; that were known by you, or should have (7) Products which, after distribution or sale reasonably been known by you, at the time by you, have been labeled or relabeled the property was transferred or abandoned. or used as a container, part or 4. Broad Form Property Damage - Borrowed ingredient of any other thing or Equipment, Customers Goods, Use of Elevators substance by or for the vendor; a. The following is added to SECTION II - (8) Bodily injury or property damage LIABILITY, B. Exclusions, 1. Applicable To arising out of the sole negligence of the Business Liability Coverage, k. Damage to vendor for its own acts or omissions or Property: those of its employees or anyone else Paragraph (4) does not apply to "property acting on its behalf. However, this exclusion does not apply to: damage" to borrowed equipment while at a jobsite and not being used to perform (a) The exceptions contained within the operations. exclusion in subparagraphs (4) or (6)above; or Para 3 (4) and (6) do not apply to Paragraph ( )� "property damage" to "customers goods" (b) Such inspections, adjustments, tests while on your premises nor to the use of or servicing as the vendor has elevators. agreed to make or normally b. For the purposes of this endorsement, the undertakes to make in the usual following course of business, in connection g definition is added to SECTION II - with the distribution or sale of the LIABILITY, F. Liability and Medical Expenses products. Definitions: (9) Bodily injury" or "property damage" 1. "Customers r goods" means ur emproperty of the arising out of an occurrence that took your place before you have signed the purpose of being: contract or agreement with the vendor. a. Worked on; or (10)To any person or organization included b. Used in your manufacturing process. as an insured by another endorsement c. The insurance afforded under this provision is issued by us and made part of this excess over any other valid and collectible Coverage Part. property insurance (including deductible) (11)Any insured person or organization, available to the insured whether primary, from whom you have acquired such excess, contingent or on any other basis. products, or any ingredient, part or container, entering into, accompanying 5. Incidental Malpractice - Employed Nurses, EMT's or containing such products. and Paramedics d. With respect to the insurance afforded to SECTION II - LIABILITY, C. Who Is An Insured, these vendors, the following is added to paragraph 2.a.(1)(d) does not apply to a nurse, SECTION II - LIABILITY, D. Liability a Medical Expense Limits of Insurance: APPROVED By Cynthia Mora at 11:35 am, Dec 05, 2024 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 3 of 6 Hanover Insurance Group.. OBFJ100553 5701807 emergency medical technician or paramedic o. Recall of Products, Work or Impaired employed by you if you are not engaged in the Property is replaced by the following: business or occupation of providing medical, o. Recall of Products, Work or Impaired paramedical, surgical, dental, x-ray or nursing Property services. 6. Personal Injury - Broad Form Damages claimed for any loss, cost or expense incurred by you or others for a. SECTION II - LIABILITY, B. Exclusions, 2. the loss of use, withdrawal, recall, Additional Exclusions Applicable only to inspection, repair, replacement, "Personal and Advertising Injury", paragraph adjustment, removal or disposal of: e. is deleted. (1) "Your product"; b. SECTION II - LIABILITY, F. Liability and (2) "Your work"; or Medical Expenses Definitions, 14. "Personal and advertising injury", paragraph b. is (3) "Impaired property"; replaced by the following: If such product, work or property is b. Malicious prosecution or abuse of withdrawn or recalled from the market or process. from use by any person or organization c. The following is added to SECTION II - because of a known or suspected defect, LIABILITY, F. Liability and Medical Expenses deficiency, inadequacy or dangerous Definitions, Definition 14. "Personal and condition in it, but this exclusion does advertising injury": not apply to "product, recall expenses" that you incur for the covered recall of "Discrimination" (unless insurance thereof is "your product". prohibited by law) that results in injury to the However, the exception to the exclusion feelings or reputation of a natural person, does not apply to "product recall but only if such "discrimination" is: (1) Not done intentionally by or at the expenses„ resulting from: direction of: (4) Failure of any products to accomplish their intended purpose; (a) The insured; (5) Breach of warranties of fitness, (b) Any officer of the corporation, quality, durability or performance; director, stockholder, partner or (6) Loss of customer approval, or any member of the insured; and cost incurred to regain customer (2) Not directly or indirectly related to an approval; "employee", not to the employment, (7) Redistribution or replacement of prospective employment or termination "your product" which has been of any person or persons by an insured. recalled by like products or d. For purposes of this endorsement, the substitutes; following definition is added to SECTION II - (8) Caprice or whim of the insured; LIABILITY, F. Liability and Medical Expenses Definitions: (9) A condition likely to cause loss of 1. "Discrimination" means the unlawful which any insured knew or had treatment of individuals based upon race, reason to know at the inception of color, ethnic origin, gender, religion, age, this insurance; or sexual preference. "Discrimination" (10)Asbestos, including loss, damage or does not include the unlawful treatment clean up resulting from asbestos or of individuals based upon developmental, asbestos containing materials; or physical, cognitive, mental, sensory or (11)Recall of "your products" that have emotional impairment or any no known or suspected defect solely combination of these. because a known or suspected e. This coverage does not apply if liability defect in another of "your products" coverage for "personal and advertising has been found. injury" is excluded either by the provisions of b. The following is added to SECTION II - the Coverage Form or any endorsement LIABILITY, C. Who Is An Insured, paragraph thereto. 3.b.: 7. Product Recall Expense "Product recall expense" arising out of any a. SECTION II - LIABILITY, B. Exclusions, 1. withdrawal or recall that occurred before you Applicable To Business Liability Coverage acquired or formed the organization. APPROVED By Cynthia Mora at 11:35 am, Dec 05, 2024 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 4 of 6 c. The following is added to SECTION II - of a deductible amount, you shall LIABILITY, D. Liability and Medical Expenses promptly reimburse us for the part of the Limits of Insurance: deductible amount we paid. Product Recall Expense Limits of Insurance The Product Recall Expense Limits of a. The Limits of Insurance shown in the Insurance apply separately to each SUMMARY OF COVERAGES of this consecutive annual period and to any endorsement and the rules stated below remaining period of less than 12 months, fix the most that we will pay under this starting with the beginning of the policy Product Recall Expense Coverage period shown in the Declarations, unless the regardless of the number of: policy period is extended after issuance for an additional period of less than 12 months. (1) Insureds; In that case, the additional period will be (2) "Covered Recalls" initiated; or deemed part of the last preceding period for (3) Number of "your products" the purposes of determining the Limits of withdrawn. Insurance. b. The Product Recall Expense Aggregate d. The following is added to SECTION II - Limit is the most that we will reimburse LIABILITY, E. Liability and Medical Expense General Conditions, 2. Duties in the Event of you for the sum of all "product recall expenses" incurred for all "covered Occurrence, Offense, Claim or Suit: recalls" initiated during the policy period. You must see to it that the following are c. The Product Recall Each Occurrence done in the event of an actual or anticipated covered recall that may result in product Limit is the most we will pay in connection with any one defect or recall expense deficiency. (1) orlve us notificationpthattice"youorf any discovery product" must d. All product recall expenses in be withdrawn or recalled. Include a connection with substantially the same description of "your product" and the general harmful condition will be deemed to arise out of the same defect reason for the withdrawal or recall; or deficiency and considered one (2) Cease any further release, shipment, "occurrence". consignment or any other method of e. Any amount reimbursed for "product distribution of like or similar products recall expenses" in connection with any until it has been determined that all one "occurrence" will reduce the amount such products are free from defects that of the Product Recall Expense Aggregate could be a cause of loss under this Limit available for reimbursement of insurance. "product recall expenses" in connection e. For the purposs of this endorsement, the with any other defect or deficiency. following definitions are added to SECTION f. If the Product Recall Expense Aggregate II - LIABILITY, F. Liability and Medical Limit has been reduced by Expenses Definitions: reimbursement of "product recall 1. "Covered recall" means a recall made expenses to an amount that is less than necessary because you or a government the Product Recall Expense Each body has determined that a known or Occurrence Limit, the remaining suspected defect, deficiency, Aggregate Limit is the most that will be inadequacy, or dangerous condition in available for reimbursement of "product "your product" has resulted or will result recall expenses" in connection with any in "bodily injury" or "property damage". other defect or deficiency. 2. "Product recall expense(s)" means: g. Product Recall Deductible a. Necessary and reasonable expenses We will only pay for the amount of for: "product recall expenses" which are in (1) Communications, including radio excess of the $500 Product Recall or television announcements or Deductible. The Product Recall printed advertisements including Deductible applies separately to each stationary, envelopes and "covered recall". The limits of insurance postage; will not be reduced by the amount of this deductible. We may, or will if required by law, pay all or any part of any deductible amount, if APPROVED applicable. Upon notice of our payment By Cynthia Mora at 11:35 am, Dec 05, 2024 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 5 Of 6 Hanover Insurance Group.. OBFJ100553 5701807 (2) Shipping the recalled products (1) If the "products - completed operations from any purchaser, distributor or hazard" is excluded from coverage under user to the place or places this Coverage Part including any designated by you; endorsement thereto; or (3) Remuneration paid to your (2) To "product recall expense" arising out of regular "employees" for any of "your products" that are otherwise necessary overtime; excluded from coverage under this (4) Hiring additional persons, other Coverage Part including endorsements than your regular "employees"; thereto. (5) Expenses incurred by"employees" 8. Unintentional Failure to Disclose Hazards including transportation and The following is added to SECTION II - accommodations; LIABILITY, E. Liability and Medical Expenses (6) Expenses to rent additional General Conditions: warehouse or storage space; Representations (7) Disposal of "your product", but We will not disclaim coverage under this only to the extent that specific Coverage Part if you fail to disclose all hazards methods of destruction other than existing as of the inception date of the policy those employed for trash provided such failure is not intentional. discarding or disposal are 9, Unintentional Failure to Notify required to avoid "bodily injury" The following is added to SECTION II or property damage as a result g - of such disposal, LIABILITY, E. Liability and Medical Expenses General Conditions, 2. Duties in the Event of you incur exclusively for the purpose Occurrence Offense Claim or Suit: of recalling "your product"; and ' Your rights afforded under this Coverage Part b. Your lost profit resulting from such shall not be prejudiced if you fail to give us "covered recall". notice of an "occurrence", offense, claim or "suit", f. This Product Recall Expense Coverage does solely due to your reasonable and documented not apply: belief that the "bodily injury", "property damage" or "personal and advertising injury" is not covered under this Policy. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. APPROVED By Cynthia Mora at 11:35 am, Dec 05, 2024 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 6 of 6 Hanover Insurance 0-011p.. OBFJ100553 5701807 1. SECTION I - PROPERTY, if two or more of However, if you agree in a written this coverage part's coverages apply to contract, written agreement, or the same loss or damage, we will not pay written permit that the insurance more than the actual amount of the loss or provided to any person or damage. organization included as an 2. SECTION II - LIABILITY, it is our stated Additional Insured under this intent that the various Coverage Parts, Coverage Part is primary and forms, endorsements or policies issued to non-contributory, we will not seek the named insured by us, or any company contribution from any other affiliated with us, do not provide any insurance available to that Additional duplication or overlap of coverage for the Insured which covers the Additional same claim, "suit", "occurrence", offense, Insured as a Named Insured except: accident, "wrongful act" or loss. We will (1) For the sole negligence of the not pay more than the actual amount of Additional Insured; or the loss or damage. (2) When the Additional Insured is If this Coverage Part and any other an Additional Insured under Coverage Part, form, endorsement or another liability policy. policy issued to the named insured by us, b. Excess Insurance or any company affiliated with us, apply to the same claim, "suit", occurrence, This insurance is excess over: offense, accident, "wrongful act" or loss, (1) Any of the other insurance, the maximum Limit of Insurance under all whether primary, excess, such Coverage Parts, forms, contingent or on any other basis: endorsements or policies combined shall (a) That is Fire, Extended not exceed the highest applicable Limit of Insurance under any one Coverage Part, Coverage, Builder's Risk, form, endorsement or policy. Installation Risk similar w This condition does not apply to any coverage for your work"; (b) That is Property Insurance for Excess or Umbrella Policy issued by us specifically to apply as excess insurance premises rented to you or over this policy. temporarily occupied by you G. Liberalization with permission of the owner; If we adopt an revision that would broaden (c) That is insurance purchased p Y by you to cover your liability the coverage under this policy without as a tenant for "property additional premium within 45 days prior to or damage" to premises rented during the policy period, the broadened to you or temporarily coverage will immediately apply to this policy. occupied by you with H. Other Insurance permission of the owner; or 1. SECTION I - PROPERTY (d) If the loss arises out of the If there is other insurance covering the maintenance or use ofaircraft, "autos" or watercraft same loss or damage, we will pay only for to aircraft, the extent not subject to the amount of covered loss or damage in SECTION - LIABILITY, excess of the amount due from that other Exclusion g. Aircraft, Auto or insurance, whether you can collect on it or Watercraft; and not. But, we will not pay more than the applicable Limit of Insurance of SECTION 1 (2) Any other primary insurance - PROPERTY. available to you covering liability 2. SECTION II - LIABILITY for damages arising out of the premises or operations, or the If other valid and collectible insurance is products and completed available to the insured for a loss we operations, for which you have cover under SECTION II - LIABILITY, our been added as an additional obligations are limited as follows: insured by attachment of an a. Primary Insurance endorsement. This insurance is primary except when When this insurance is excess, we paragraph b. below applies. If this will have no duty under SECTION II - insurance is primary, our obligations LIABILITY to defend the insured are not affected unless any of the against any suit if any other other insurance is also primary. Then, insurer has a duty to defend the insured against that "suit". If no other we will share with all that other insurer defends, we will undertake to insurance by the method described in paragraph c. below. do so, but we will be entitled to the 391-1003 08 16 Includes copyrighted material APPROVED 79 of 81 By Cynthia Mora at 11:35 am, Dec 05, 2024 insured's rights against all those other premium in accordance with our rates and insurers. rules then in effect. c. When this insurance is excess over other 3. With our consent, you may continue this insurance, we will pay only our share of policy in force by paying a continuation the amount of the loss, if any, that premium for each successive one-year exceeds the sum of: period. The premium must be: (1) The total amount that all such other a. Paid to us prior to the anniversary insurance would pay for the loss in date; and the absence of this insurance; and b. Determined in accordance with (2) The total of all deductible and paragraph 2. above. self-insured amounts under all that Our forms then in effect will apply. If you other insurance. do not pay the continuation premium, this d. We will share the remaining loss, if any, policy will expire on the first anniversary with any other insurance that is not date that we have not received the described in this provision and was not premium. bought specifically to apply in excess of 4. Undeclared exposures or change in your the Limits of Insurance shown in the business operation, acquisition or use of Declarations for this Coverage. locations may occur during the policy e. Method of Sharing period that is not shown in the If all of the other insurance permits Declarations. If so, we may require an contribution by equal shares, we will additional premium. That premium will be follow this method also. Under this determined in accordance with our rates approach each insurer contributes equal and rules then in effect. amounts until it has paid its applicable J. Premium Audit Limit of Insurance or none of the loss 1. This policy is subject to audit if a premium remains, whichever comes first. designated as an advance premium is If any of the other insurance does not shown in the Declarations. We will permit contribution by equal shares, we compute the final premium due when we will contribute by limits. Under this determine your actual exposures. method, each insurer's share is based on 2. Premium shown in this policy as advance the ratio of its applicable Limit of premium is a deposit premium only. At the Insurance to the total applicable limits of close of each audit period, we will insurance of all insurers. compute the earned premium for that f. When this insurance is excess, we will period and send notice to the first Named have no duty under Business Liability Insured. The due date for audit premiums Coverage to defend any claim or "suit" is the date shown as the due date on the that any other insurer has a duty to bill. If the sum of the advance and audit defend. If no other insurer defends, we premiums paid for the policy period is will undertake to do so; but we will be greater than the earned premium, we will entitled to the insured's rights against all return the excess to the first Named those other insurers. Insured. I. Premiums 3. The first Named Insured must keep 1. The first Named Insured shown in the records of the information we need for Declarations: premium computation and send us copies at such times as we may request. p a. responsible for the payment of all K. Transfer of Rights of Recovery Against Others premiums; and to Us b. Will be the payee for any return premiums we pay. 1. Applicable to SECTION I - PROPERTY 2. The premium shown in the Declarations was Coverage: computed based on rates in effect at the time If any person or organization to or for the policy was issued. On each renewal, whom we make payment under this policy continuation or anniversary of the effective has rights to recover damages from date of this policy, we will compute the another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 391-1003 08 16 Includes copyrighted material of In APPROVED 80 of 81 By Cynthia Mora at 11:35 am, Dec 05, 2024 r��, Harnover Insurance Group.. OBFJ100553 5701807 a. Prior to a loss to your Covered We waive any right of recovery we may Property. have against any person or b. After a loss to your Covered Property organization with whom you have a only if, at time of loss, that party is written contract, permit or agreement one of the following: to waive any rights of recovery against such person or organization because of (1) Someone insured by this payments we make for injury or insurance; damage arising out of your ongoing (2) A business firm: operations or "your work" done under a (a) Owned or controlled by you; contract with that person or organization and included in the or "products-completed operations (b) That owns or controls you; or hazard". (3) Your tenant. This condition does not apply to You may also accept the usual bills of Medical Expenses Coverage. lading or shipping receipts limiting the L. Transfer of Your Rights and Duties Under liability of carriers. This Policy This will not restrict your insurance. Your rights and duties under this policy 2. Applicable to SECTION II - LIABILITY may not be transferred without our written Coverage: consent except in the case of death of an individual Named Insured. If you die, your If the insured has rights to recover all or rights and duties will be transferred to your part of any payment we have made legal representative but only while that under this Coverage Part, those rights legal representative is acting within the are transferred to us. The insured must scope of their duties as your legal do nothing after loss to impair such representative. Until your legal rights. At our request, the insured will representative is appointed, anyone with bring "suit" or transfer those rights to us proper temporary custody of your property and help us enforce them. will have your rights and duties but only with respect to that property. APPROVED By Cynthia Mora at 11:35 am, Dec 05, 2024 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 81 of 81 78/8/2025 E(MM/DD/YYYY) ACTOR" CERTIFICATE 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 CONTACT NAME: Danl Schulze AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX 3697 Mt. Diablo Blvd Suite 230 A/C No Ext: 714-202-0390 A/C,No): E-MLafayette CA 94549 ADDRESS: CertsDesignPro@AssuredPartners.com INSURER(S)AFFORDING COVERAGE NAIC# License#:6003745 INSURERA:Aspen Specialty Insurance Company 10717 INSURED PROAENG-01 INSURER B: Citizens Insurance Company of America 31534 Proactive Engineering Consultants INSURERC:Allmerica Financial Benefit Insurance Company 41840 200 S. Main Street, Suite 300 Corona CA 92882 INSURERD: Hartford Casualty Insurance Company 29424 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:568411107 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD B X COMMERCIAL GENERAL LIABILITY Y Y OBFJ100553 8/7/2025 8/7/2026 EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PRO- POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y Y AWFJ100189 8/7/2025 8/7/2026 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLALIAB X OCCUR Y Y OBFJ100553 8/7/2025 8/7/2026 EACH OCCURRENCE $5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$n $ D WORKERS COMPENSATION Y 57WEGBH5UCM 8/7/2025 8/7/2026 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? FN] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liability AAAE300254-05 8/7/2025 8/7/2026 Per Claim $2,000,000 Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The following policies are included in the underlying schedule of insurance for umbrella/excess liability:General Liability/Auto Liability/Employers Liability/Employee Benefits Liability. Re:All Operations of the Named Insured. The City of Santa Ana, its officers,officials,employees and volunteers are named as an additional insured as respects general liability as required per written contract. General Liability is Primary/Non-Contributory per policy form wording. Tu Tran T�T,anyN9uYe by APPROVED Date:2025.08.,, Nguyen 09:48:,6-oroo By Tu'Tran Nguyen at 9:47 arts,Aug 11,2025 CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 ` @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Hanover Insurance Group.. AWFJ100189 5701807 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART A. The following is added to SECTION II - Primary and Non-Contributory LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured: If you agree in a written contract, written agreement or written permit that the insurance Additional Insured if Required by Contract provided to a person or organization who If you agree in a written contract, written qualifies as an additional "insured" under agreement or written permit that a person or SECTION II - LIABILITY COVERAGE, Paragraph organization be added as an additional A.1. Who Is An Insured, subparagraph "insured" under this Coverage Part, such Additional Insured if Required by Contract is person or organization is an "insured"; but only primary and non-contributory, the following to the extent that such person or organization applies: qualifies as an "insured" under paragraph A.1.c. The liability coverage provided by this Coverage of this Section. Part is primary to any other insurance available If you agree in a written contract, written to the additional "insured" as a Named Insured. agreement or written permit that a person or We will not seek contribution from any other organization be added as an additional insurance available to the additional "insured" "insured" under this Coverage Part, the most except: we will pay on behalf of such additional (1) For the sole negligence of the additional "insured" is the lesser of: "insured"; or (1) The Limits of Insurance for liability coverage (2) For negligence arising out of the ownership, specified in the written contract, written maintenance or use of any "auto" not owned agreement or written permit; or by the additional "insured" or by you, unless (2) The Limits of Insurance for Liability that "auto" is a "trailer" connected to an Coverage shown in the Declarations "auto" owned by the additional "insured" or applicable to this Coverage Part. by you; or Such amount shall be part of and not in addition (3) When the additional "insured" is also an to the Limits of Insurance shown in the additional "insured" under another liability Declarations applicable to this Coverage Part. policy. Regardless of the number of covered "autos", C. This endorsement will apply only if the "insureds", premiums paid, claims made or "accident" occurs: vehicles involved in the "accident", the most we 1. During the policy period; will pay for the total of all damages and "covered pollution cost or expense" combined 2. Subsequent to the execution of the written resulting from any one "accident" is the Limit of contract or written agreement or the Insurance for Liability Coverage shown in the issuance of the written permit; and Declarations. 3. Prior to the expiration of the period of time B. The following is added to SECTION IV - that the written contract, written agreement BUSINESS AUTO CONDITIONS, Paragraph B. or written permit requires such insurance to General Conditions, subparagraph 5. Other be provided to the additional "insured". Insurance: D. Coverage provided to an additional "insured" will not be broader than coverage provided to any other "insured" under this Coverage Part. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 461-0478 12 12 Includes copyrighted material of ISO Insurance Services Office, Inc.,with its permission Page 1 of 1 005244 0218 of 0219 Hanover Insurance Group.. AWFJ100189 5701807 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. CANCELLATION EXTENSION d. Any business entity for which you Paragraph A. CANCELLATION 2. b. of the have a financial interest greater COMMON POLICY CONDITIONS is than 50% of the voting stock or replaced with the following: otherwise have a controlling b. 60 days before the effective date interest after the effective date of of cancellation if we cancel for this policy or that is newly any other reason. acquired or formed by you during the term of this policy. SECTION I - COVERED AUTOS The coverage provided by this 2. EMPLOYEE HIRED "AUTOS" provision is afforded until Description Of Covered Auto expiration or termination of Designation Symbols; Symbol 8 is this policy, whichever occurs replaced by the following: earlier. 8 = Hired "Autos" Only - Only those The coverage provided by this "autos" you lease, hire, rent or borrow; provision does not apply to including "autos" your employee hires at any business entity described your direction, for the purpose of in d. above that qualifies as an conducting your business. This does not insured under any other include any "auto" you lease, hire, rent, or automobile liability policy borrow from any of your "employees" or issued to that business entity partners or members of their households. as a named insured or would have been an insured except SECTION II - LIABILITY COVERAGE for the exhaustion of the policy limits or the insolvency 3. BROADENED NAMED INSURED of the insurer. The following is added to the SECTION II - The coverage provided by this LIABILITY COVERAGE, Paragraph 1. Who provision does not apply to Is An Insured provision: "bodily injury" nor "property damage" arising from an accident that occurred prior to your acquiring or forming the business entity described in d. above. Includes copyrighted material of Insurance Services Office, Inc. with its permission, Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 1 of 7 005230 0204 of 0219 4. EMPLOYEES AS INSUREDS SECTION III - PHYSICAL DAMAGE COVERAGE. The following is added to the SECTION II - LIABILITY COVERAGE, Paragraph 1. Who 7. EXPENSE OF RETURNING A STOLEN Is An Insured provision: "AUTO" and SIGN COVERAGE e. Any employee of yours is an The following is added to SECTION III - "insured" while using a covered PHYSICAL DAMAGE COVERAGE, A.1. "auto" you do not own, hire or COVERAGE: borrow in your business or your personal affairs. d. Expense Of Returning A Stolen "Auto" 5. SUPPLEMENTARY PAYMENTS The following amends SECTION II - We will pay for the expense of LIABILITY COVERAGE, Paragraph 2. returning a covered "auto" to you. Coverage Extensions provision: e. Sign Coverage Paragraph (2) is replaced by the following: We will pay for loss to signs, (2) Up to $2500 for cost of bail bonds murals, paintings or graphics, (including bonds for related traffic as part of equipment, which are law violations) required because displayed on a covered "auto". of an "accident" we cover. We do not have to furnish these bonds. The most we will pay for "loss" in Paragraph (4) is replaced by the following: any one "accident" is the lesserof: (4) All reasonable expenses incurred by the "insured" at our request, 1. The actual cash value of including actual loss of earnings the property as of the up to $500 a day because of time time of the "loss"; or off from work. 2. The cost of repairing or replacing the damaged or 6. AMENDED FELLOW EMPLOYEE stolen property with other EXCLUSION property of like kind and quality; or The following is added to the SECTION II - 3. $2,000. LIABILITY COVERAGE, B. Exclusions Fellow Employee 8. GLASS BREAKAGE DEDUCTIBLE This exclusion does not apply if the The following is added to SECTION III - "bodily injury" arises from the use of a PHYSICAL DAMAGE COVERAGE, A. covered "auto" you own or hire. This COVERAGE paragraph 3. Glass Breakage - coverage is excess over any other Hitting a Bird or Animal - Falling Objects collectible insurance or Missiles: Any deductible shown in the Declarations as applicable to the Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 2 of 7 Hanover Insurance Group.. AWFJ100189 5701807 covered "auto' will not apply to glass direction, for the purpose of breakage if such glass is repaired, conducting your business, for a rather than replaced. period of 30 days or less, of like kind and use as the "autos" you 9. TRANSPORTATION EXPENSE own, subject to the following: Paragraph 4. Coverage Extension. of The most we will pay for any one SECTION III - PHYSICAL DAMAGE loss is the lesser of the following: COVERAGE, A. COVERAGE is replaced with the following: a. $50,000 per accident, or b. cash value, or 4. Coverage Extension c. the cost of repair, We will pay up to $50 per day to a minus the deductible equal to the maximum of$1500 for temporary lowest deductible applicable to transportation expense incurred any owned "auto' for that by you because of the total theft of coverage. Any deductible shown a covered "auto' of the private in the Declarations does not apply passenger type. We will pay only to "loss" caused by fire or for those covered "autos" for lightning. Subject to the limit and which you carry either deductible stated above, we will Comprehensive or Specified provide coverage equal to the Causes of Loss Coverage. We will broadest coverage provided to pay for temporary transportation any covered "auto' you own, that expenses incurred during the is applicable to the loss. period beginning 24 hours after the theft and ending, regardless of If the loss arises from an accident the policy s expiration, when the for which you are legally liable covered "auto' is returned to use and the lessor incurs an actual or we pay for its "loss". financial loss from that accident, we will cover the lessor s actual 10. HIRED AUTO PHYSICAL DAMAGE financial loss of use of the hired "auto" for a period of up to seven The following is added to SECTION III - consecutive days from the date of PHYSICAL DAMAGE COVERAGE, A. the accident, subject to a limit of COVERAGE: $1,000 per accident. 5. Hired Auto Physical Damage AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE If hired "autos" are covered "autos" for Liability Coverage and The following is added to SECTION III - if Physical Damage Coverage of PHYSICAL DAMAGE COVERAGE, A. Comprehensive, Specified Causes COVERAGE: of Loss, or Collision is provided under this Coverage Form for any 6. Audio, Visual and Data Electronic "auto" you own, then the Physical Equipment Coverage Damage Coverage(s) provided is extended to "autos" you hire We will pay for "loss" to any without a driver or your employee electronic equipment that receives hires, without a driver, at your Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 3 of 7 005231 0205 of 0219 or transmits audio, visual or data equipment is permanently signals and that is not designed installed in the covered solely for the reproduction of "auto", and sound. This coverage applies b. Permanently installed only if the equipment is in the opening of the dash permanently installed in the or console normally used covered "auto" at the time of the by the manufacturer for "loss" or the equipment is the installation of a radio. removable from a housing unit which is permanently installed in With respect to coverage herein, the covered auto at the time of the LIMIT OF INSURANCE the "loss", and such equipment is provision of PHYSICAL DAMAGE designed to be solely operated by COVERAGE is replaced by the use of the power from the "auto s" following: electrical system, in or upon the covered "auto", including its 1. The most we will pay for all antennas and other accessories. "loss" to audio, visual or data However , this does not include electronic equipment and any tapes, records or discs. accessories used with this equipment as a result of any The exclusions that apply to one "accident" is the lesser of PHYSICAL DAMAGE COVERAGE, except for the exclusion relating to a. The actual cash value of Audio, Visual and Data Electronic the damaged or stolen Equipment, also apply to coverage property as of the time of provided herein. In addition, the the "loss"; or following exclusions apply: b. The cost of repairing or replacing the damaged or We will not pay , under this stolen property with other coverage, for either any electronic property of like kind and equipment or accessories used quality; or with such electronic equipment c. $500. that is: 2. An adjustment for 1. Necessary for the normal depreciation and physical operation of the covered condition will be made in "auto" or the monitoring of determining actual cash value the covered "auto s" at the time of the "loss". operating system; or 3. Deductibles applicable to 2. Both: PHYSICAL DAMAGE COVERAGE, do not apply a. An integral part of the to this Audio, Visual and Data same unit housing any Electronic Equipment sound reproducing Coverage. equipment designed solely for the If there is other coverage provided reproduction of sound if by this policy for audio, visual and the sound reproducing data electronic equipment, the coverage provided herein is Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 4 of 7 Hanover Insurance Group.. AWFJ100189 5701807 excess. However, you may elect covered"auto". If loss is to apply the limit or any portion caused by theft, this thereof of coverage provided number of days is added herein to pay any deductible that to the number of days it is applicable under the provisions takes to locate the covered of the other coverage. "auto" and transport it to a repair shop. 12. RENTAL REIMBURSEMENT and MATERIAL TRANSFER EXPENSE 2. 60 days. The following is added to SECTION III - Our payment is limited to the PHYSICAL DAMAGE COVERAGE, A. lesser of the following amounts: COVERAGE: 1. Necessary and actual 7. Rental Reimbursement and expenses incurred, Material Transfer Expense including loss of use. This coverage provides only those 2. $3000. Physical Damage Coverages where a premium is shown in the This auto rental expense coverage Declarations. It applies only to a does not apply while there are covered "auto" described or spare or reserve "autos" available designated to which the Physical to you for your operations. Damage Coverages apply. If"loss" results from the total theft We will pay for auto rental of a covered "auto" of the private expenses and the expenses, passenger type, we will pay under incurred by you because of"loss" this coverage only that amount of to a covered "auto", to remove your rental reimbursement and transfer your materials and expenses which is not already equipment from the covered provided for under the SECTION "auto" . Payment applies in III - PHYSICAL DAMAGE addition to the otherwise COVERAGE, A. 4. Coverage applicable amount of each Extension. coverage you have on a covered "auto". No deductibles apply to 13. AIRBAG COVERAGE this coverage. SECTION III - We will pay only for those auto PHYSICAL DAMAGE COVERAGE, B. rental expenses incurred during Exclusions, paragraph 3. the policy period beginning 24 hours after the "loss" and ending, The portion of this exclusion relating to regardless of the policy s mechanical or electrical breakdown does expiration, with the lesser of the not apply to the accidental discharge of an following number of days: airbag. This coverage is excess of other collectible insurance or warranty. No 1. The number of days deductible applies to this Airbag reasonably required to Coverage. repair or replace the Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 5 of 7 005232 0206 of 0219 14. AUTO LOAN PHYSICAL DAMAGE imposed under a lease for excessive use, EXTENSION abnormal wear and tear or high mileage; security deposits not refunded by the The following is added to SECTION III - lessor; cost for extended warranties, PHYSICAL DAMAGE COVERAGE, C. Limit Credit Life Insurance, Health, Accident or Of Insurance provision: Disability Insurance purchased with the loan; and carry over balances from When a "loss" results in a total loss to a previous leases. covered auto you own for which a Loss Payee is designated in this policy, the This coverage applies only to the initial most we will pay for "loss" in any one lease for the covered "auto" which has not "accident" is the greater of: previously been leased. This coverage is excess over all other collectible 1. The actual cash value of the insurance. damaged or stolen property as of the time of the "loss"; or SECTION IV - CONDITIONS 2. The outstanding balance of the 16. DUTIES IN THE EVENT OF ACCIDENT, initial loan, less any amounts for CLAIM, SUIT OR LOSS taxes, overdue payments, overdue payment charges, penalties, The following is added to SECTION IV - interest , any charges for early BUSINESS AUTO CONDITIONS, A. Loss termination of the loan, costs for Conditions, 2. Duties In The Event Of Credit Life Insurance, Health, Accident, Claim, Suit Or Loss: Accident or Disability Insurance purchased with the loan, and d. Knowledge of any "accident", carry-over balances from previous claim, "suit" or "loss" will be loans. deemed knowledge by you when notice of such "accident", 15. AUTO LEASE PHYSICAL DAMAGE claim, "suit" or "loss" has been EXTENSION received by: The following is added to SECTION III - (1) You, if you are an individual; PHYSICAL DAMAGE COVERAGE, C. Limit (2) Any partner or insurance Of Insurance provision: manager if you are a partnership; or If, because of damage, destruction or theft (3) An executive officer or of a covered "auto", which is a long-term insurance manager if you are leased "auto", the lease agreement a corporation. between you and the lessor is terminated, "we" will pay the difference between the 17. BLANKET WAIVER OF SUBROGATION amount paid under paragraph C. LIMIT OF INSURANCE 1. or 2. and the amount due Paragraph 5. Transfer Of Rights Of at the time of"loss" under the terms of Recovery Against Others To Us, SECTION the lease agreement applicable to the IV - BUSINESS AUTO CONDITIONS, A. leased "auto" which you are required to Loss Conditions is replaced by the pay: less any fees to dispose of the auto; following: any overdue payments; financial penalties Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 461-0155 (9-97) Page 6 of 7 Hanover Insurance Group.. AWFJ100189 5701807 5. Transfer Of Rights Of Recovery 19. HIRED AUTO - WORLDWIDE Against Others To Us COVERAGE If any person or organization to or The following is added to SECTION IV - for whom we make payment Business Auto Conditions, B. General under this Coverage Form has Conditions, paragraph 7. Policy Period, rights to recover damages from Coverage Territory provision: another, which have not been waived through the execution of e. Outside the coverage territory an "insured contract", written described in a., b., c., and d. agreement, or permit, prior to the above for an "accident" or "loss" "accident" or "loss" giving rise to resulting from the use of a the payment, those rights to covered "auto" you hire, without a recover damages from another driver, or your employee hires are transferred to us. That person without a driver, at your direction, or organization must do for the purpose of conducting your everything necessary to secure business, for a period of 30 days our rights and must do nothing or less, provided the suit is after the "accident" or "loss" to brought within The United States impair them. of America or its territories or possessions. 18. UNINTENTIONAL FAILURE TO DISCLOSE INFORMATION SECTION V - DEFINITIONS The following is added to SECTION IV 20. MENTAL ANGUISH BUSINESS AUTO CONDITIONS. B. General Conditions, paragraph 2. Paragraph C. 'Bodily injury", SECTION V - Concealment, Misrepresentation Or Fraud: DEFINITIONS is replaced by the following: Your unintentional error in disclosing, C. "Bodily injury" means bodily injury, or failure to disclose, any material fact sickness or disease sustained by a existing after the effective date of this person including death or mental Coverage Form shall not prejudice anguish resulting from any of these. your rights under this Coverage Form. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc., 1996 041 461-0155 (9-97) Page 7 of 7 005233 0207 of 0219 Policy # OBFJ100553 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES Limits Page 1. Additional Insured by Contract, Agreement or Permit Included 1 2. Additional Insured - Broad Form Vendors Included 2 3. Alienated Premises Included 3 4. Broad Form Property Damage - Borrowed Equipment, Customers Included 3 Goods and Use of Elevators 5. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) Included 3 6. Personal and Advertising Injury - Broad Form Included 4 7. Included 4 Product Recall Expense Each Occurrence Limit $25,000 5 Occurrence Product Recall Expense Aggregate Limit $50,000 5 Aggregate Product Recall Deductible $500 5 8. Unintentional Failure to Disclose Hazards Included 6 9. Unintentional Failure to Notify Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II - (2) Premises you own, rent, lease or LIABILITY: occupy; or 1. Additional Insured by Contract, Agreement or (3) Your maintenance, operation or use of Permit equipment leased to you. The following is added to SECTION II - b. The insurance afforded to such additional LIABILITY, C. Who Is An Insured: insured described above: Additional Insured by Contract, Agreement or (1) Only applies to the extent permitted by Permit law; and a. Any person or organization with whom you (2) Will not be broader than the insurance agreed in a written contract, written which you are required by the contract, agreement or permit to add such person or agreement or permit to provide for such organization as an additional insured on additional insured. your policy is an additional insured only with (3) Applies on a primary basis if that is respect to liability for bodily injury , required by the written contract, written property damage", or personal and agreement or permit. advertising injury" caused, in whole or in part, by your acts or omissions, or the acts (4) Will not be broader than coverage or omissions of those acting on your behalf, provided to any other insured. but only with respect to: (5) Does not apply if the "bodily injury", (1) "Your work" for the additional insured(s) "property damage" or "personal and designated in the contract, agreement or advertising injury"is otherwise excluded permit; from coverage under this Coverage Part, including any endorsements thereto. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 1 of 6 Hanover Insurance Group.. OBFJ100553 5701807 c. This provision does not apply: The most we will pay on behalf of the (1) Unless the written contract or written additional insured for a covered claim is the agreement was executed or permit was lesser of the amount of insurance: issued prior to the "bodily injury", 1. Required by the contract, agreement or "property damage", or "personal injury permit described in Paragraph a.; or and advertising injury". 2. Available under the applicable Limits of (2) To any person or organization included Insurance shown in the Declarations. as an insured by another endorsement This endorsement shall not increase the issued by us and made part of this applicable Limits of Insurance shown in the Coverage Part. Declarations (3) To any lessor of equipment: e. All other insuring agreements, exclusions, (a) After the equipment lease expires; or and conditions of the policy apply. (b) If the "bodily injury", "property 2. Additional Insured - Broad Form Vendors damage", "personal and advertising The following is added to SECTION II - injury" arises out of sole negligence LIABILITY, C. Who Is An Insured: of the lessor. (4) To any: Additional Insured - Broad Form Vendors (a) Owners or other interests from whom a. Any person or organization that is a vendor land has been leased if the with whom you agreed in a written contract "occurrence" takes place or the additional insured under this Coverage Part offense is committed after the lease is an insured, but only with respect to liability for the land expires; or for "bodily injury" or "property damage" (b) Managers or lessors of premises if: arising out of "your products" which are (i) The "occurrence" takes place or distributed or sold in the regular course of the offense is committed after the vendors business. you cease to be a tenant in that b. The insurance afforded to such vendor premises; or described above: (ii) The "bodily injury", "property (1) Only applies to the extent permitted by damage", "personal injury" or law; "advertising injury" arises out of (2) Will not be broader than the insurance structural alterations, new which you are required by the contract or construction or demolition agreement to provide for such vendor; operations performed by or on behalf of the manager or lessor. (3) Will not be broader than coverage (5) To "bodily injury", "property damage" or provided to any other insured; and "personal and advertising injury" arising (4) Does not apply if the "bodily injury", out of the rendering of or the failure to "property damage" or "personal and render any professional services. advertising injury" is otherwise excluded This exclusion applies even if the claims from coverage under this Coverage Part, against any insured allege negligence or including any endorsements thereto other wrongdoing in the supervision, c. With respect to insurance afforded to such hiring, employment, training or vendors, the following additional exclusions monitoring of others by that insured, if apply: the "occurrence" which caused the The insurance afforded to the vendor does "bodily injury" or "property damage" or not apply to: the offense which caused the "personal and advertising injury" involved the (1) "Bodily injury" or "property damage" for rendering of or failure to render any which the vendor is obligated to pay professional services or for you. damages by reasons of the assumption of liability in a contract or agreement. This d. With respect to the insurance afforded to exclusion does not apply to liability for these additional insureds, the following is damages that the insured would have in added to SECTION II - LIABILITY, D. Liability the absence of the contract or and Medical Expense Limits of Insurance: agreement; (2) Any express warranty unauthorized by you; 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 2 of 6 005144 0118 of 0219 (3) Any physical or chemical change in the The most we will pay on behalf of the vendor product made intentionally by the for a covered claim is the lesser of the vendor; amount of insurance: (4) Repackaging, unless unpacked solely for 1. Required by the contract or agreement the purpose of inspection, described in Paragraph a.; or demonstration, testing, or the 2. Available under the applicable Limits of substitution of parts under instruction Insurance shown in the Declarations; from the manufacturer, and then repackaged in the original container; This endorsement shall not increase the (5) Any failure to make such inspection, applicable Limits of Insurance shown in the adjustments, tests or servicing as the Declarations. vendor has agreed to make or normally 3. Alienated Premises undertakes to make in the usual course SECTION II - LIABILITY, B. Exclusions, 1. of business in connection with the sale Applicable To Business Liability Coverage k. of the product; Damage to Property, paragraph (2) is replaced by (6) Demonstration, installation, servicing or the following: repair operations, except such (2) Premises you sell, give away or abandon, if operations performed at the vendor's the "property damage" arises out of any part premises in connection with the sale of of those premises and occurred from hazards the product; that were known by you, or should have (7) Products which, after distribution or sale reasonably been known by you, at the time by you, have been labeled or relabeled the property was transferred or abandoned. or used as a container, part or 4. Broad Form Property Damage - Borrowed ingredient of any other thing or Equipment, Customers Goods, Use of Elevators substance by or for the vendor; a. The following is added to SECTION II - (8) "Bodily injury" or "property damage" LIABILITY, B. Exclusions, 1. Applicable To arising out of the sole negligence of the Business Liability Coverage, k. Damage to vendor for its own acts or omissions or Property: those of its employees or anyone else Paragraph (4) does not apply to "property acting on its behalf. However, this exclusion does not apply to: damage" to borrowed equipment while at a jobsite and not being used to perform (a) The exceptions contained within the operations. exclusion in subparagraphs (4) or (6)above; or Paragraph (3), (4) and (6) do not apply to "property damage" to "customers goods" (b) Such inspections, adjustments, tests while on your premises nor to the use of or servicing as the vendor has elevators. agreed to make or normally b. For the purposes of this endorsement, the couundertakes to make in with t of business, in the usual connectionhe distribution or sale of the following definition is added to SECTION II - LIABILITY, F. Liability and Medical Expenses with t products. Definitions: (9) "Bodily injury" or "property damage" 1. "Customers goods" means property of your customer on your premises for the place before you have signed the purpose of being: contract or agreement with the vendor. a. Worked on; or (10)To any person or organization included b. Used in your manufacturing process. as an insured by another endorsement c. The insurance afforded under this provision is issued by us and made part of this excess over any other valid and collectible Coverage Part. property insurance (including deductible) (11)Any insured person or organization, available to the insured whether primary, from whom you have acquired such excess, contingent or on any other basis. products, or any ingredient, part or container, entering into, accompanying 5. Incidental Malpractice - Employed Nurses, EMT's or containing such products. and Paramedics d. With respect to the insurance afforded to SECTION II - LIABILITY, C. Who Is An Insured, these vendors, the following is added to paragraph 2.a.(1)(d) does not apply to a nurse, SECTION II - LIABILITY, D. Liability and Medical Expense Limits of Insurance: 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 3 of 6 Hanover Insurance Group.. OBFJ100553 5701807 emergency medical technician or paramedic o. Recall of Products, Work or Impaired employed by you if you are not engaged in the Property is replaced by the following: business or occupation of providing medical, o. Recall of Products, Work or Impaired paramedical, surgical, dental, x-ray or nursing Property services. 6. Personal Injury - Broad Form Damages claimed for any loss, cost or expense incurred by you or others for a. SECTION II - LIABILITY, B. Exclusions, 2. the loss of use, withdrawal, recall, Additional Exclusions Applicable only to inspection, repair, replacement, "Personal and Advertising Injury", paragraph adjustment, removal or disposal of: e. is deleted. (1) "Your product"; b. SECTION II - LIABILITY, F. Liability and Medical Expenses Definitions, 14. "Personal (2) "Your work"; or and advertising injury", paragraph b. is (3) "Impaired property"; replaced by the following: If such product, work or property is b. Malicious prosecution or abuse of withdrawn or recalled from the market or process. from use by any person or organization c. The following is added to SECTION II - because of a known or suspected defect, LIABILITY, F. Liability and Medical Expenses deficiency, inadequacy or dangerous Definitions, Definition 14. "Personal and condition in it, but this exclusion does advertising injury": not apply to "product recall expenses" that you incur for the "covered recall" of "Discrimination" (unless insurance thereof is "your product". prohibited by law) that results in injury to the However, the exception to the exclusion feelings or reputation of a natural person, does not apply to "product recall but only if such "discrimination" is: expenses" resulting from: (1) Not done intentionally by or at the direction of: (4) Failure of any products to accomplish their intended purpose; (a) The insured; (5) Breach of warranties of fitness, (b) Any officer of the corporation, quality, durability or performance; director, stockholder, partner or member of the insured; and (6) Loss of customer approval, or any cost incurred to regain customer (2) Not directly or indirectly related to an approval; "employee", not to the employment, prospective employment or termination (7) Redistribution or replacement of any person or persons by an insured. "your product" which has been recalled by like products or d. For purposes of this endorsement, the substitutes; following definition is added to SECTION II - (8) Caprice or whim of the insured; LIABILITY, F. Liability and Medical Expenses Definitions: (9) A condition likely to cause loss of 1. "Discrimination" means the unlawful which any insured knew or had treatment of individuals based upon race, reason to know at the inception of color, ethnic origin, gender, religion, age, this insurance; or sexual preference. "Discrimination" (10)Asbestos, including loss, damage or does not include the unlawful treatment clean up resulting from asbestos or of individuals based upon developmental, asbestos containing materials; or physical, cognitive, mental, sensory or (11)Recall of "your products" that have emotional impairment or any no known or suspected defect solely combination of these. because a known or suspected e. This coverage does not apply if liability defect in another of "your products" coverage for "personal and advertising has been found. injury" is excluded either by the provisions of b. The following is added to SECTION II - the Coverage Form or any endorsement LIABILITY, C. Who Is An Insured, paragraph thereto. 3.b.: 7. Product Recall Expense "Product recall expense" arising out of any a. SECTION II - LIABILITY, B. Exclusions, 1. withdrawal or recall that occurred before you Applicable To Business Liability Coverage, acquired or formed the organization. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 4 of 6 005145 0119 of 0219 c. The following is added to SECTION II - of a deductible amount, you shall LIABILITY, D. Liability and Medical Expenses promptly reimburse us for the part of the Limits of Insurance: deductible amount we paid. Product Recall Expense Limits of Insurance The Product Recall Expense Limits of a. The Limits of Insurance shown in the Insurance apply separately to each SUMMARY OF COVERAGES of this consecutive annual period and to any endorsement and the rules stated below remaining period of less than 12 months, fix the most that we will pay under this starting with the beginning of the policy Product Recall Expense Coverage period shown in the Declarations, unless the regardless of the number of: policy period is extended after issuance for an additional period of less than 12 months. (1) Insureds; In that case, the additional period will be (2) "Covered Recalls" initiated; or deemed part of the last preceding period for (3) Number of "your products" the purposes of determining the Limits of withdrawn. Insurance. b. The Product Recall Expense Aggregate d. The following is added to SECTION II - Limit is the most that we will reimburse LIABILITY, E. Liability and Medical Expense you for the sum of all "product recall General Conditions, 2. Duties in the Event of expenses" incurred for all "covered Occurrence, Offense, Claim or Suit: recalls" initiated during the policy period. You must see to it that the following are c. The Product Recall Each Occurrence done in the event of an actual or anticipated covered recall that may result in product Limit is the most Each will pay in connection with any one defect or recall expense": deficiency. (1) Give us prompt notice of any discovery d. All "product recall expenses" in or notification that "your product" must connection with substantially the same be withdrawn or recalled. Include a general harmful condition will be description of your product and the deemed to arise out of the same defect reason for the withdrawal or recall; or deficiency and considered one (2) Cease any further release, shipment, "occurrence". consignment or any other method of e. Any amount reimbursed for "product distribution of like or similar products recall expenses in connection with any until it has been determined that all one "occurrence" will reduce the amount such products are free from defects that of the Product Recall Expense Aggregate could be a cause of loss under this Limit available for reimbursement of insurance. "product recall expenses" in connection e. For the purposs of this endorsement, the with any other defect or deficiency. following definitions are added to SECTION f. If the Product Recall Expense Aggregate II - LIABILITY, F. Liability and Medical Limit has been reduced by Expenses Definitions: reimbursement of "product recall 1. "Covered recall" means a recall made expenses" to an amount that is less than necessary because you or a government the Product Recall Expense Each body has determined that a known or Occurrence Limit, the remaining suspected defect, deficiency, Aggregate Limit is the most that will be inadequacy, or dangerous condition in available for reimbursement of "product "your product" has resulted or will result recall expenses" in connection with any In "bodily injury" or "property damage". other defect or deficiency. 2. "Product recall expense(s)" means: g. Product Recall Deductible a. Necessary and reasonable expenses We will only pay for the amount of for: "product recall expenses" which are in (1) Communications, including radio excess of the $500 Product Recall or television announcements or Deductible. The Product Recall printed advertisements including Deductible applies separately to each stationary, envelopes and "covered recall". The limits of insurance postage; will not be reduced by the amount of this deductible. We may, or will if required by law, pay all or any part of any deductible amount, if applicable. Upon notice of our payment 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 6 of 6 Hanover Insurance Group.. OBFJ100553 5701807 (2) Shipping the recalled products (1) If the "products - completed operations from any purchaser, distributor or hazard" is excluded from coverage under user to the place or places this Coverage Part including any designated by you; endorsement thereto; or (3) Remuneration paid to your (2) To "product recall expense" arising out of regular "employees" for any of "your products" that are otherwise necessary overtime; excluded from coverage under this (4) Hiring additional persons, other Coverage Part including endorsements than your regular "employees"; thereto. (5) Expenses incurred by"employees" 8• Unintentional Failure to Disclose Hazards including transportation and The following is added to SECTION II - accommodations; LIABILITY, E. Liability and Medical Expenses (6) Expenses to rent additional General Conditions: warehouse or storage space; Representations (7) Disposal of "your product", but We will not disclaim coverage under this only to the extent that specific Coverage Part if you fail to disclose all hazards methods of destruction other than existing as of the inception date of the policy those employed for trash provided such failure is not intentional. discarding or disposal are 9. Unintentional Failure to Notify required to avoid "bodily injury" The following is added to SECTION II or property damage as a result g - of such disposal, LIABILITY, E. Liability and Medical Expenses General Conditions, 2. Duties in the Event of you incur exclusively for the purpose Occurrence, Offense, Claim or Suit: of recalling "your product"; and Your rights afforded under this Coverage Part b. Your lost profit resulting from such shall not be prejudiced if you fail to give us "covered recall". notice of an "occurrence", offense, claim or "suit", f. This Product Recall Expense Coverage does solely due to your reasonable and documented not apply: belief that the "bodily injury", "property damage" or "personal and advertising injury" is not covered under this Policy. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 6 of 6 005146 0120 of 0219 ` Tne Policy# OBFJ100553 ` Hanover Proactive Engineering 1. SECTION I - PROPERTY, if two or more of However, if you agree in a written this coverage part's coverages apply to contract, written agreement, or the same loss or damage, we will not pay written permit that the insurance more than the actual amount of the loss or provided to any person or damage. organization included as an 2. SECTION II - LIABILITY, it is our stated Additional Insured under this intent that the various Coverage Parts, Coverage Part is primary and forms, endorsements or policies issued to non-contributory, we will not seek the named insured by us, or any company contribution from any other affiliated with us, do not provide any insurance available to that Additional duplication or overlap of coverage for the Insured which covers the Additional same claim, "suit", "occurrence", offense, Insured as a Named Insured except: accident, "wrongful act" or loss. We will (1) For the sole negligence of the not pay more than the actual amount of Additional Insured; or the loss or damage. (2) When the Additional Insured is If this Coverage Part and any other an Additional Insured under Coverage Part, form, endorsement or another liability policy. policy issued to the named insured by us, b. Excess Insurance or any company affiliated with us, apply to the same claim, "suit", occurrence, This insurance is excess over: offense, accident, "wrongful act" or loss, (1) Any of the other insurance, the maximum Limit of Insurance under all whether primary, excess, such Coverage Parts, forms, contingent or on any other basis: endorsements or policies combined shall (a) That is Fire, Extended not exceed the highest applicable Limit of Coverage, Builder's Risk, Insurance under any one Coverage Part, similar form, endorsement or policy. coverage for"your work Installation Risk or This condition does not apply to any Excess or Umbrella Policy issued by us (b) That is Property Insurance for specifically to apply as excess insurance premises rented to you or over this policy. temporarily occupied by you G. Liberalization with permission of the owner; If we adopt an revision that would broaden (c) That is insurance purchased P Y by you to cover your liability the coverage under this policy without as a tenant for "property additional premium within 45 days prior to or damage" to premises rented during the policy period, the broadened to you or temporarily coverage will immediately apply to this policy. occupied by you with H. Other Insurance permission of the owner;or 1. SECTION I -PROPERTY (d) If the loss arises out of the If there is other insurance covering the maintenance or use of same loss or damage, we will pay only for aircraft, autos" or watercraft to the extent not subject to the amount of covered loss or damage in SECTION II - LIABILITY, excess of the amount due from that other Exclusion g. Aircraft, Auto or insurance, whether you can collect on it or Watercraft;and not. But, we will not pay more than the applicable Limit of Insurance of SECTION 1 (2) Any other primary insurance -PROPERTY. available to you covering liability 2. SECTION II -LIABILITY for damages arising out of the premises or operations, or the If other valid and collectible insurance is products and completed available to the insured for a loss we operations, for which you have cover under SECTION II - LIABILITY, our been added as an additional obligations are limited as follows: insured by attachment of an a. Pri marylnsurance endorsement. This insurance is primary except when When this insurance is excess,we paragraph b. below applies. If this will have no duty under SECTION II - insurance is primary, our obligations LIABILITY to defend the insured are not affected unless any of the against any "suit' if any other other insurance is also primary. Then, insurer has a duty to defend the we will share with all that other insured against that "suit". If no other insurance by the method described in insurer defends, we will undertake to paragraph c. below. do so, but we will be entitled to the 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 79 of 81 insured's rights against all those other premium in accordance with our rates and insurers. rules then in effect. c. When this insurance is excess over other 3. With our consent, you may continue this insurance, we will pay only our share of policy in force by paying a continuation the amount of the loss, if any, that premium for each successive one-year exceeds the sum of: period.The premium must be: (1) The total amount that all such other a. Paid to us prior to the anniversary insurance would pay for the loss in date; and the absence of this insurance; and b. Determined in accordance with (2) The total of all deductible and paragraph 2.above. self-insured amounts under all that Our forms then in effect will apply. If you other insurance. do not pay the continuation premium, this d. We will share the remaining loss, if any, policy will expire on the first anniversary with any other insurance that is not date that we have not received the described in this provision and was not premium. bought specifically to apply in excess of 4. Undeclared exposures or change in your the Limits of Insurance shown in the business operation, acquisition or use of Declarations for this Coverage. locations may occur during the policy e. Method of Sharing period that is not shown in the If all of the other insurance permits Declarations. If so, we may require an contribution by equal shares, we will additional premium. That premium will be follow this method also. Under this determined in accordance with our rates approach each insurer contributes equal and rules then in effect. amounts until it has paid its applicable J. Premium Audit Limit of Insurance or none of the loss 1. This policy is subject to audit if a premium remains, whichever comes first. designated as an advance premium is If any of the other insurance does not shown in the Declarations. We will permit contribution by equal shares, we compute the final premium due when we will contribute by limits. Under this determine your actual exposures. method, each insurer's share is based on 2. Premium shown in this policy as advance the ratio of its applicable Limit of premium is a deposit premium only.At the Insurance to the total applicable limits of close of each audit period, we will insurance of all insurers. compute the earned premium for that f. When this insurance is excess, we will period and send notice to the first Named have no duty under Business Liability Insured. The due date for audit premiums Coverage to defend any claim or "suit" is the date shown as the due date on the that any other insurer has a duty to bill. If the sum of the advance and audit defend. If no other insurer defends, we premiums paid for the policy period is will undertake to do so; but we will be greater than the earned premium, we will entitled to the insured's rights against all return the excess to the first Named those other insurers. Insured. I. Premiums 3. The first Named Insured must keep 1. The first Named Insured shown in the records of the information we need for Declarations: premium computation and send us copies a. Is responsible for the payment of all at such times as we may request. premiums; and K. Transfer of Rights of Recovery Against Others to Us b. Will be the payee for any return premiums we pay. 1. Applicable to SECTION I - PROPERTY 2. The premium shown in the Declarations was Coverage: computed based on rates in effect at the time If any person or organization to or for the policy was issued. On each renewal, whom we make payment under this policy continuation or anniversary of the effective has rights to recover damages from date of this policy, we will compute the another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 80 of 81 Tie Hanover Insurance Group_ a. Prior to a loss to your Covered We waive any right of recovery we may Property. have against any person or b. After a loss to your Covered Property organization with whom you have a only if, at time of loss, that party is written contract, permit or agreement one of the following: to waive any rights of recovery against such person or organization because of (1) Someone insured by this payments we make for injury or insurance; damage arising out of your ongoing (2) A business firm: operations or "your work" done under a (a) Owned or controlled by you; contract with that person or organization and included in the or "products-completed operations (b) That owns or controls you;or hazard". (3) Your tenant. This condition does not apply to You may also accept the usual bills of Medical Expenses Coverage. lading or shipping receipts limiting the L. Transfer of Your Rights and Duties Under liability of carriers. This Policy This will not restrict your insurance. Your rights and duties under this policy 2. Applicable to SECTION II - LIABILITY may not be transferred without our written Coverage: consent except in the case of death of an individual Named Insured_ If you die, your If the insured has rights to recover all or rights and duties will be transferred to your part of any payment we have made legal representative but only while that under this Coverage Part, those rights legal representative is acting within the are transferred to us_ The insured must scope of their duties as your legal do nothing after loss to impair such representative. Until your legal rights. At our request, the insured will representative is appointed, anyone with bring suit or transfer those rights to us proper temporary custody of your property and help us enforce them. will have your rights and duties but only with respect to that property. 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc„ with its permission. Page 81 of 81 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS Policy Number:57wEGBH5UCM Endorsement Number: Effective Date:08/07/2025 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: proactive Engineering Consultants 200 S.Main Street,Suite 300 Corona,CA 92882 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: INDEX SUBJECT PAGE SUBJECT PAGE SECTION 1 2 B. Part One Does Not Apply 3 PARTS ONE and TWO 2 C. Application of Coverage 3 01 We Will Also Pay 2 D. Additional Exclusions 3 PART-THREE 2 E. West Virginia 3 02 How This Insurance Works 2 EXTENDED OPTIONS 4 PART-SIX 2 01 Employers' Liability Insurance 4 03 Transfer of Your Rights and Duties 2 02 Unintentional Failure to Disclose 4 04 Liberalization 2 Hazards SECTION II 2 03 Waiver of Our Right to Recover from 4 VOLUNTARY COMPENSATION 2 Others INSURANCE 04 Foreign Voluntary Compensation 4 05 Voluntary Compensation Insurance 2 A. How This Reimbursement Applies 4 A. How This Insurance Applies 2 B. We Will Reimburse 4 B. We Will Pay 3 C. Exclusions 4 C. Exclusions 3 D. Before We Pay 5 D. Before We Pay 3 E. Recovery From Others 5 E. Recovery From Others 3 F. Reimbursement For Actual Loss 5 F. Employers' Liability Insurance 3 Sustained EMPLOYERS' LIABILITY STOP GAP 3 G. Repatriation 5 ENDORSEMENT H. Endemic Disease 5 06 Employers' Liability Stop Gap 3 05 Longshore and Harbor Workers' 5 Coverage Compensation Act Coverage A. Stop Gap Coverage Limited to 3 Endorsement Montana, North Dakota, Ohio, SECTION III 6 Washington, West Virginia and 01 Schedule of Covered States 6 Wyoming Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 1 of 6 Process Date: 8i8i2025 Policy Expiration Date:08/07/2026 ©2000, The Hartford SECTION I PARTS ONE and TWO PART THREE 1. WE WILL ALSO PAY 2. How This Insurance Applies D. We Will Also Pay of Part One (WORKERS' Paragraph 4. of A. How This Insurance Applies of COMPENSATION INSURANCE); and Part 3 (Other States Insurance) is replaced by the E. We Will Also Pay of Part Two following: (EMPLOYERS' LIABILITY INSURANCE) is 4. If you have work on the effective date of this replaced by the following: policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded We Will Also Pay for that state unless we are notified within sixty We will also pay these costs, in addition to days. other amounts payable under this insurance, as part of any claim, proceeding, or suit we PART SIX defend: 3. Transfer Of Your Rights and Duties 1. reasonable expenses incurred at our C. Transfer Of Your Rights and Duties of Part 6 request, INCLUDING loss of earnings; (Conditions) is replaced by the following: 2. premiums for bonds to release Your rights or duties under this policy may not be attachments and for appeal bonds in transferred without our written consent. bond amounts up to the limit of our liability under this insurance; If you die and we receive notice within sixty days 3. litigation costs taxed against you; after your death, we will cover your legal representative as insured. 4. interest on a judgment as required by law 4. Liberalization until we offer the amount due under this law; and If we adopt a change in this form that would broaden 5. expenses we incur. the coverage of this form without extra charge, the broader coverage will apply to this policy. It will apply when the change becomes effective in your state. SECTION II VOLUNTARY COMPENSATION ANDEMPLOYERS' 3. The bodily injury must occur in the United LIABILITY COVERAGE States of America, its territories or 5. Voluntary Compensation Insurance possessions, or Canada, and may occur elsewhere if the employee is a United States A. How This Insurance Applies or Canadian citizen, or otherwise legal This insurance applies to bodily injury by resident, and legally employed, in the United accident or bodily injury by disease. Bodily States or Canada and temporarily away from injury includes resulting death. those places. 1. The bodily injury must be sustained by 4. Bodily injury by accident must occur during any officer or employee not subject to the the policy period. workers' compensation law of any state 5. Bodily injury by disease must be caused or shown in Item 3.A. of the Information aggravated by the conditions of the Page. 2. The bodily injury must arise out of and in the course of employment or incidental to work in a state shown in Item 3.A. of the Information Page. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 2 of 6 officer's or employee's employment. The If the persons entitled to the benefits of this officer's or employee's last day of last insurance make a recovery from others, they exposure to the conditions causing or must reimburse us for the benefits we paid them. aggravating such bodily injury by disease F. Employers' Liability Insurance must occur during the policy period. Part Two (Employers' Liability Insurance) applies B. We Will Pay to bodily injury covered by this endorsement as We will pay an amount equal to the benefits though the State of Employment was shown in that would be required of you as if you and Item 3.A. of the Information Page. your employees were subject to the workers' This provision 5. does not apply in New Jersey or compensation law of any state shown in Item Wisconsin. 3.A. of the Information Page. We will pay those amounts to the persons who would be EMPLOYERS' LIABILITY STOP GAP COVERAGE entitled to them under the law. 6. Employers' Liability Stop Gap Coverage C. Exclusion A. This coverage only applies in Montana, North This insurance does not cover: Dakota, Ohio, Washington, West Virginia and 1. any obligation imposed by workers' Wyoming. compensation or occupational disease B. Part One (Workers' Compensation Insurance) law or any similar law. does not apply to work in states shown in 2. bodily injury intentionally caused or Paragraph A above. aggravated by you. C. Part Two (Employers' Liability Insurance) applies in the states, shown in Paragraph A., as though 3. officers or employees who have elected they were shown in Item 3.A. of the Information not to be subject to the state workers' Page. compensation law. D. Part Two, Section C. Exclusions is changed by 4. partners or sole proprietors not covered adding these exclusions. under the Standard Sole Proprietors, Partners, Officers and Others Coverage This insurance does not cover; Endorsement. 5. bodily injury intentionally caused or D. Before We Pay aggravated by you or in Ohio bodily injury resulting from an act which is determined by Before we pay benefits to the persons an Ohio court of law to have been committed entitled to them, they must: by you with the belief than an injury is 1. Release you and us, in writing, of all substantially certain to occur. However, the responsibility for the injury or death. cost of defending such claims or suits in Ohio 2. Transfer to us their right to recover from is covered. others who may be responsible for the 13. bodily injury sustained by any member of the injury or death. flying crew of any aircraft. 3. Cooperate with us and do everything 14. any claim for bodily injury with respect to necessary to enable us to enforce the which you are deprived of any defense or right to recover from others. defenses or are otherwise subject to penalty If the persons entitled to the benefits of this because of default in premium under the insurance fail to do those things, our duty to provisions of the workers' compensation law pay ends at once. If they claim damages or laws of a state shown in Paragraph A. from you or from us for the injury or death, E. This insurance applies to damages for which you our duty to pay ends at once. are liable under West Virginia Code Annot. S 23- E. Recovery From Others 4-2. If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we paid. We will pay the balance to the persons entitled to it. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 3 of 6 EXTENDED OPTIONS 1. Employers' Liability Insurance 4. Foreign Voluntary Compensation and Employers' Item 3.13. of the Information Page is replaced by Liability Reimbursement the following: A. How This Reimbursement Applies B. Employers' Liability Insurance: This reimbursement provision applies to bodily 1. Part Two of the policy applies to work in injury by accident or bodily injury by disease. each state listed in Item 3.A. Bodily injury includes resulting death. 1. The bodily injury must be sustained by an The Limits of Liability under Part Two are officer or employee. the higher of: 2. The bodily injury must occur in the course of employment necessary or incidental to work Bodily Injury in a country not listed in Exclusion C.1. of this by Accident $500,000 Each Accident provision. 3. Bodily injury by accident must occur during Bodily Injury the policy period. by Disease $500,000 Policy Limit 4. Bodily injury by disease must be caused or aggravated by the conditions of your Bodily Injury employment. The officer or employee's last by Disease $500,000 Each Employee exposure to those conditions of your employment must occur during the policy OR period. B. We Will Reimburse 2. The amount shown in the Information We will reimburse you for all amounts paid by Page. you whether such amounts are: This provision 1 of EXTENDED OPTIONS does 1. voluntary payments for the benefits that not apply in New York because the Limits Of Our would be required of you if you and your Liability are unlimited. officers or employees were subject to any In this provision the limits are changed from workers' compensation law of the state of $500,000 to $1,000,000 in California. hire of the individual employee. 2. Unintentional Failure to Disclose Hazards 2. sums to which Part Two (Employers' Liability If you unintentionally should fail to disclose all Insurance) would apply if the Country of existing hazards at the inception date of your Employment were shown in Item 3.A. of the policy, we shall not deny coverage under this Information Page. policy because of such failure. C. Exclusions 3. Waiver of Our Right To Recover From Others This insurance does not cover: A. We have the right to recover our payments 1. any occurrences in the United States, from anyone liable for an injury covered by Canada, and any country or jurisdiction this policy. We will not enforce our right which is the subject of trade or economic against any person or organization for whom sanctions imposed by the laws or regulations you perform work under a written contract of the United States of America in effect as of that requires you to obtain this agreement the inception date of this policy. from us. 2. any obligation imposed by a workers' This agreement shall not operate directly or compensation or occupational disease law, indirectly to benefit anyone not named in the or similar law. agreement. 3. bodily injury intentionally caused or B. This provision 3. does not apply in the states aggravated by you. of Pennsylvania and Utah. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 4 of 6 4. liability for any consequence, whether of America necessarily incurred as a direct result direct or indirect, of war, invasion, act of of bodily injury. Foreign enemy, hostilities (whether war Our reimbursement shall be limited as follows: be declared or not), civil war, rebellion, revolution, insurrection or military or 1. to the amount by which such expenses usurped power. No endorsement now or exceed the normal cost of returning the subsequently attached to this policy shall officer or employee if in good health, or be construed as overriding or waiving 2. in the event of death, to the amount by which this limitation unless specific reference is such expenses exceed the normal cost of made thereto. returning the officer or employee if alive and D. Before We Pay in good health. Before we reimburse you for the benefits to In no event shall our reimbursement exceed the the persons entitled to them, you must have bodily injury by accident limit shown in Item 3.13. them: of the Information Page as respects any one 1. release you and us, in writing, of all such officer or employee whether dead or alive. responsibility for the injury or death, H. Endemic Disease 2. transfer to us their right to recover from The word "disease" includes any endemic others who may be responsible for their diseases. injury or death, The coverage applies as if endemic diseases 3. cooperate with us and do everything were included in the provisions of the workers' necessary to enable us to enforce the compensation law. right to recover from others. 5. Longshore and Harbor Workers' Compensation If the persons entitled to the benefits paid fail Act Coverage to do these things, our duty to reimburse General Section C. Workers' Compensation Law ends at once. If they claim damages from us is replaced by the following: for the injury or death, our duty to reimburse C. Workers' Compensation Law ends at once. Workers' Compensation Law means the workers E. Recovery From Others or workers' compensation law and occupational If we make a recovery from others, we will disease law of each state or territory named in keep an amount equal to our expenses of Item 3.A. of the Information Page and the recovery and the benefits we reimbursed. Longshore and Harbor Workers' Compensation We will pay the balance to the persons Act (33 USC Sections 901-950). It includes any entitled to it. If persons entitled to the amendments to those laws that are in effect benefits make a recovery from others, they during the policy period. It does not include any must repay us for the amounts that we have other federal workers or workers' compensation reimbursed you. law, other federal occupational disease law or the F. Reimbursement for Actual Loss provisions of any law that provide Sustained nonoccupational disability benefits. This endorsement provides only for Part Two (Employers' Liability Insurance), C. reimbursement for the loss you actually Exclusions, exclusion 8, does not apply to work sustain. In order for you to recover loss or subject to the Longshore and Harbor Workers' expenses under this reimbursement you Compensation Act. must: This coverage does not apply to work subject to 1. actually sustain and pay the loss or the Defense Base Act, the Outer Continental expense in money after trial, or Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. 2. secure our consent for the payment of the loss or expense. G. Repatriation Our reimbursement includes the additional expenses of repatriation to the United States Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 5 of 6 SECTION III 1. SCHEDULE OF COVERED STATES B. If a state, shown in Item 3.A. of the Information A. This endorsement only applies in the states Page, approves this endorsement after the listed in this Schedule of Covered States. effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval C. Schedule of Covered States: CA Countersigned by Authorized Representative Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 6 of 6 MAYOR ACTING CITY MANAGE Valerie AmezcLia ; Alvaro Nunez MAYOR PRO TEf CiTY ATTORNEY Thai Viet Phan Sonia R.Caovaiho COUNCILMENBERS µ CITY CLERK Phil Bacerra ; Jennifer L. Hull Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza a P.O. Box 1988 Santa Ana,California 92702 vvw+awv.Santa-g_qa, rq Felix Gonzalez, PE Director of Commercial Engineering Proactive Engineering Consultants (PEC) 16755 Von barman Ave, Suite 150 Irvine, CA 9 666 Bear Felix Gonzalez, Thank you for informing us about the upcoming changes regarding Adams Streeter transitioning operations to Proactive Engineering Consultants (PEC). We acknowledge and appreciate the notice regarding this name change. We are pleased to continue our contractual arrangements with your team under, the new name, Proactive Engineering Consultants, Our team will share the new vendor registration forms with you. Kindly fill out these forms and send them back to us so that we can update our records promptly and ensure timely (payment. Once we receive the completed forms, kindly ensure that all future correspondence and invoices are issued under the name of PEC. We look forward to maintaining our collaborative efforts with your engineering teams without interruption. Should there be any administrative adjustments needed from our end to accommodate this transition, please do not hesitate to inform us. Thank you once again for your prompt communication. If you have any questions or require further clarification, please feel free to reach out to me directly. Best regards„,-, Cesar E. rr �a--'.'.,,. Deputy Public Works Director/ Water Resources Manager SANITA ANA CITY COUNCIL Viicrie Arnezma Thai Viet Phan Benjamin Vazquez Jessie Lopez F fl Racerra Johnailaan Ryan Hernandez David Peoadloza Mayor Mayor Pro Tem,Ward 9 Ward;2 Ward 3 Ward 4 Ward d Ward fiJ vamt;.zcue(-a7s vT..Ca-ana.,ofg tp6ran s�airr1a-acva:.�q�7rr. trvazoueoz&sanla-ana.arcd tr's!E opezLwsantamrrv_a.�rg baca*,iia(Vx);anti.-aoa.M ir, YYerrYrin�lw.(Carsawy�ta-�na.a ripenpItrzp(Ll!5gni1a-tana.+avy