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HomeMy WebLinkAboutDOMINGUEZ GENERAL ENGINEERING, INC. (2)A-2021-132-04A MAYOR Valerie Amezcua MAYOR PRO TEM Thai Viet Phan COUNCILMEMBERS Phil Became Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez CITY OF SANTA ANA INSURANCE ON FILE PUBLIC WORKS AGENCY WORK MAY PROCEED 20 Civic Center Plaza . P.O. Box 1988 UNTIL NNSURANCE EXPIRES Santa Ana, California 92702 l o I I P-p 7-4 w .santa-ana.ore CITY CLERK DATE: JUL 2 9 2024 June 13,2024 0.. Pvv R(-,7) Dominguez General Engineering, Inc. L4�a P"rOv"' 11096 Pipeline Ave. Pomona, CA 91766 Attn: Adolfo Dominguez, President ACTING CITY MANAGER Alvaro Nunez CITY ATTORNEY Sonia R. Cervalho CITY CLERK Jennifer L. Hall Re: Extension of Agreement (A-2021-132-04) for Sewer System Repair Services Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Dominguez General Engineering, Inc., and the City of Santa Ana, dated July 20, 2021, the time period of the Agreement is hereby extended for an additional two-year period, from July 20, 2024 through July 19, 2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, AVM Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF TTANA GY.y Alvaro Nunez Acting City Manager APPROVED AS TO FORM ATTEST Jennifer L. II - Ci Cle i DOMINGUEZ GENERAL ENGINEERING, INC. KYwNcllesen Alcja6ilro Dominguez Ai istant City Attorney Vice President SANTA ANA CITY COUNCIL Valetla pmaxcua Tai Viet Ppan Benpmin Vazquez A.I. Lopez Phil Bacemd JohnaMan Rya, HemaiWez IY3yor Mayer Pm Tem, Wam Ma 2 Wa 3 Wa 4 W.W5 zmaasentea,a om Iptrnas nl na om bvamuazOaanteana.,m ssielnnazasanpana pm oha�snarmaenta-ana n" Irvannemamu®sama-ana om DaAd Peml,za Waw 6 CERTIFICATE OF LIABILITY INSURANCE OAT 0620/20//024 2024Y) 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 OF70482 1-562-270-0787 CONTA,: NAME: 'ah9a L,•Gurro JL Gurrola Insurance Age Anaie PHONE 5 Jr s E-MAIL cert catesno 1 100 N. Broadway Su1te 30ADORE.!: gia.c I SUAR(EL6FE0000V NAICp Long Beach, CA 90802 INSURI t,: a I 41297 INSURED Dominguez General Engineering, Inc. dba Dominguez General Hng rin n ct�\x' INSU' 2RB: Uni ed Financial Casualty Company 11770 L INP RERC: > T ie u e i"I �y p ny 16045 • 35378 11096 Pipeline Ave. V e 25674 ORE a Is sop rt Cas 1 Pomona 6 3A IN F: • • _ _ COVERAGES CFRTIFICATF NIIMRPR• 062r14 .n _ra oetnc nu wuaIA 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 LTR TYPE OF INSURANCEINSO gppL SUBR POLICY NUMBER MM/ODYEFF MM/DDfyY%1'Yl LIMBS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR X X BCS2001121 12/15/23 12/15/24 EACH OCCURRENCE $ 11000,000 PREMISES Me occurrence) $ 300,000 X MET EXP (Any one person) $ 5,000 A Deductible: $ 5,.00 PERSONAL a ADV INJURY $ 100,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [X ] jEa1:1 LOG GENERALAGGREGATE $2,000,000 PRODUCTS - COMP/OP AGO $2,000, 000 $ OTHER: AUTOMOBILE LIABILITY X X 975624551 06/15/24 12/15/24 EO BINEauddeDISINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ B % ANY AUTO OWNED % SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED % NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident ; S UMBRELLA LIAB X OCCUR XLS2003316 12/15/23 12/15/24 EACH OCCURRENCE ; 4,000,000 AGGREGATE $ 4,000,000 A X EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 0.00 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILRY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERJMEMBEREXCLUDED? NIA X 760002485123E 10/O1/23 10/01/24 _ X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS below H Property/Inland Marine X X QT-660-BS959975-TIL-23 10/01/23 10/01/29 Leased A Rented Bguipmeat $ 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORO 101, AddtUonal Remarks Schedule, may be attached R more space Is required) Re: Project No. 21-6453 NR Annexation water A Sewer Maint Improvements The City of Santa Ana, its of f i..... official., employees, and volunteer. are additional insured per attached endoreement(e). coverage is primary A non -contributor, per policy wording and attached endor.ement(s). waiver of euJorogation applies per attached endorsement(.). Rxce.. Liability 1. follow -form to the General, Auto and Rmployers Liability. 30 Day Notice of Cancellation/ 10 Day for Non -Payment rfrMN: C r1 VLYCR City of Santa Ana Risk Management Division 4th Floor 20 Civic Center Plaza Santa Ana CA 92701 USA ACORD 25 (2016103) JLGIA06 062024-01-GA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC AUTHORIZED REPRESENTATIVE Risk MumgemattlMsi A clo reel. _ REVIEWED F, APPROVED BY: ®. ® Risk Management Specialist The ACORD name and logo are registered marks of ACORD The ACORD name and logo are registered marks of ACORD 1 /10/2024 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 Re: Professional Liability Insurance Requirement Dear City of Santa Ana Risk Management Division: Dominguez General Engineering, Inc. has intent to enter into an agreement with the city of Santa Ana. Throughout the course of this agreement, Dominguez General Engineering attests that I am not a licensed professional and will not employ a licensed professional during the course of my contract with the city of Santa. By signing below, I attest that I possess the legal authority to enter into an agreement with the City of Santa as well as the legal authority to attest to the statements above. If at any time it is found that Dominguez General Engineering is not adhering to any/all statements in this document, the contract will be considered null and void and the company will be held fully liable for any and all damages. Alejan ro Dominguez Vice -President Dominguez General Engineering, Inc. (626)652-2622 dominguezgeneral@aol.com R e D � Aqu Auwto �� Risk Management SpeoAst POLICY NUMBER: 975624551 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DOMINGUEZ GENERAL ENGINEERING, INC. Endorsement Effective Date: 06/15/24 Transaction Date: 06/15/24 SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 4410 13 © Insurance Services Office, Inc., 2011 ,3 RiskMoagmtmtDMstan REVIEWED&APPROVED9Y: ® Risk Management spec Ant Page 1 of 1 POLICY NUMBER: 975624551 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: D—ingnez General Engineering, Inc. Endorsement Effective Date: 06/15/24 SCHEDULE Name Of Person(s) Or Organization(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. will be Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Ride MawgemmLD(Weime REMe D&APPROVm BY. "-W Ruk Management Spedalist OF Page 1 of 1 POLICY NUMBER: 975624551 COMMERCIAL AUTO CA 04 49 1116 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance — Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". Rmk Managematf Diuisio - \a REVIEwmd, APPROVm BY: R uk Management Spedalm CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 POLICY NUMBER: BCS2001121 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURE➢. '' ��� Risk MwagewwltDW[an �. REviEWEO&APPROvmar. A. Fr 11 'Suii111tl.:1 Risk Management Specialist '4 01 CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: BCS2001121 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) ALL PARSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. SCHEDULE A11 Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2• 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 .., Rie%Managvneiwu : REVIEWED&APPRCNmnfDBY: A+ju AaI441 ®' Ruk Management Specialist Of Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or v Y� RiskMwwgatmtDMsWn RmEw &APPawmBr. m ° 7 A,.P Aa'4 �Nwp Ruk Management SpeoAst Of Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 1219 POLICY NUMBER: BCS2001121 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for 'bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Risk Maigat adDWi,Ea REVIEWED&ArrRovsOBy. 1 1F1' A- f, Aaw.ta ® R6k Managemen[Spedallst CG 20 37 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: BCS2001121 COMMERCIAL GENERAL LIABILITY CG 24 0412 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. 1BekMarugemmtD&ielan REVIEWED&APPRWmBY: `) A+� Auvcdn ® Risk Management Specialist Of CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: IICS2001121 COMMERCIAL GENERAL LIABILITY CG 25 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by 'occur- rences" under Section 1— Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to operations at a single designated "loca- tion" shown in the Schedule above: 1. A separate Designated Location General Aggregate Limit applies to each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damag- es because of "bodily injury" or "property damage" included in the 'products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Loca- tion General Aggregate Limit for that desig- nated 'location". Such payments shall not re- duce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Location General Aggre- gate Limit for any other designated 'location" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Location General Aggre- gate Limit. CG 25 04 05 09 ©Insurance Services Office, Inc., 2008 R1AMknagemerdDi tan REVIEWED & AppR mBY: Rnk Management speaa nt 01 Pagel of 2 0 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- 'products -completed operations hazard" is pro- rences" under Section I — Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under 'bodily injury" or 'property damage" included in Section I — Coverage C, which cannot be at- the 'products -completed operations hazard" will tributed only to operations at a single designated reduce the Products -completed Operations Ag- "location" shown in the Schedule above: gregate Limit, and not reduce the General Ag- 1. Any payments made under Coverage A for gregate Limit nor the Designated Location Gen - damages or under Coverage C for medical eral Aggregate Limit. expenses shall reduce the amount available D. For the purposes of this endorsement, the Defi- under the General Aggregate Limit or the nitions Section is amended by the addition of Products -completed Operations Aggregate the following definition: Limit, whichever is applicable; and "Location" means premises involving the same or 2. Such payments shall not reduce any Desig- connecting lots, or premises whose connection is nated Location General Aggregate Limit. interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Risk ManagnnastDirielan `. ��Ff REVIEWED&APPRMM Sr. AIMME1 Risk Management Spedalis[ 01 Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 04 05 09 13 ENVIRONMENTAL Policy No. CPLMOL111737 MARKEL® EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM A. Section III — Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you perform or performed "your work" and with whom you have agreed to provide additional insured status in a written contract or agreement, provided the written contract or agreement was executed prior to the: a. Commencement of "your work"; and b. Date the "pollution condition" first commenced. 2. Any other person or organization you are required to add as an additional insured under the written contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage", or "cleanup costs" resulting from a "pollution condition" caused, in whole or in part, by "your work". However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the written contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section IV — Limits Of Insurance And Self -Insured Retention Or Deductible: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or agreement described in Paragraph A.1.; or 2. Available under the applicable limits of insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable limits of insurance shown in the Declarations. All other terms and conditions remain unchanged. MEET 2906 11 19 Includes copyrighted material of Insurance Services Office, h with its permission. op•`a RMeMnwgemadDMsirnt <�jY •N.i r&YIE D&APPRovm By: A- jz, A `®' Risk Management Spedaiist ENVIRONMENTAL gig POLICY NUMBER: CPLM01-111737 E�® EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following, where indicated by an "X" in the checkbox(es) below: ❑ COMMERCIAL GENERAL LIABILITY COVERAGE FORM ® CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM ❑ PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. The following is added to the Transfer Of Rights Of Recovery Against Others To Us condition: Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization with whom the Named Insured has agreed, in a written contract executed prior to the "occurrence" or "pollution condition", to waive such rights of recovery because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract with that person or organization. All other terms and conditions remain unchanged. MEEI 2592 08 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. "ManagemmtDMawt 1 REmEwEo & APPRavm aY Xf, Aaa44 Rak Management Spenag5t fi?`. Policy No.: QT-660-85959975-TIL-23 COMMERCIAL INLAND MARINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET LOSS PAYEES This endorsement modifies insurance provided under the COMMERCIAL INLAND MARINE COVERAGE PART The following is added to Section E - ADDITIONAL b. Pay any claim for loss or damage jointly to you COVERAGE CONDITIONS: and the Loss Payee as your interests may Loss Payable Provision appear. In the event of a Covered Cause of Loss to Covered This endorsement applies to all Covered Property for Property in which both you and a Loss Payee share which a Loss Payee is on file with us or your an insurable interest, we will: insurance agent or insurance broker. a. Adjust the loss or damage with you; and CM U618 0621 © 2021 The Travelers Indemnity Company Includes copyrighted material of Insurance Services Office, Inc with its permission. -'7 R®kManagemmfDMsion REVIEWED&APPRO EDBY. °!.1 afI R�M A+J 4 A Risk Management Specialist WORKERS COMPENSATION AND EMPLOYERS LIABDdTY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - 50miLl 1[1130 011 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 10/01/2023 Policy No. Insured: Dominguez General Engineering, Inc. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Insurance Rating Bureau of California. A0 rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. Endorsement No. 001 Premium $ INCL. „o�� t' W wekMougnaeneDMaion REvwE &APPRWID BY.' A-IpAcAak �� Risk Management Specialist A� 'a 71216/2024 MM/DD/YYYY) 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 6013466 1-562-270-0787 CONTACT NAME: Jose L. Gurrola Bear Risk Management, Inc. PHONE 562-270-0787 FAX (A/C. /C No Ext: A/C No), dba JL Gurrola Insurance Agency E-MAIL ia.comg certificatesnow@'1 ADDRESS: certificatesnow@jlgia.com 100 W. Broadway Suite 3000 INSURER(S)AFFORDING COVERAGE NAIC# Long Beach CA 90802 USA INSURERA: Scottsdale Insurance Company 41297 INSURED INSURERB: United Financial Casualty Company 11770 Dominguez General Engineering, Inc. Everest Premier Insurance Company 16045 INSURER C: P Y dba Dominguez General Engineering Contractor INSURERD: Evanston Insurance Company 35378 11096 Pipeline Ave. INSURER E: Travelers Property Casualty 25674 Pomona CA 91766 USA INSURER F: COVERAGES CERTIFICATE NUMBER: 1216-06-GA 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 IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY X X BCS2002162 12/15/24 12/15/25 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A X Deductible: $ 5,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 100,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY R1XIECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ NED AUTOMOBILE LIABILITY X X 975624551 12/15/24 06/15/25 Ea accc" ",)SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B X OWNED X SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY AUTOS $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY Per accident $ S UMBRELLALIAB X OCCUR XLS2005843 12/15/24 12/15/25 EACH OCCURRENCE $ 4,000,000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED RETENTION$ N/A $ WORKERANDEMPSYERS'LIATIONILIT X 7600024851241 10/01/24 10/01/25 X STATUTE EER ER H AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBEREXCLUDED? Y N I 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 D Contractors Pollution Lia. X X CPLMOL124441 06/10/24 06/10/25 Ea Occ & Agg Limit $ 2,000,000 E Property/Inaland Marine X X 660 3X218203 10/01/24 10/01/25 Installation Limit $ 700,000 E Property/Inaland Marine X X 660 3X218203 10/01/24 10/01/25 Lsd/Rntd Equipment $ 100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Project No. 21-6453 NE Annexation Water & Sewer Maint Improvements The City of Santa Ana, its officers, officials, employees and volunteers are additional insured per attached endorsement(s). Coverage is primary and non-contributory per policy wording and attached endorsement(s). Waiver of Subrogation applies per attached endorsement(s). Excess Liability is follow form. APPROVED By Tu Tran Nguyen at 12:01 pm,Jan 30,2025 30 Day Notice of Cancellation/ 10 Day for Non-Payment. CERTIFICATE HOLDER CANCELLATION The City of Santa Ana Risk Management Division 4th Floor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 USA ned Tu Tran by Nquy Tran en ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Nguyen 2025 Date: BEARRISK06 12 0 2 iso :zi-os as 1216-06-GA POLICY NUMBER: BCS2002162 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY ALL OPERATIONS WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily " or "property damage" damage" or "personal and advertising injury" occurring after: pp y injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III— Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: BCS2002162 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY ALL OPERATIONS WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER:BCS2002Ie2 COMMERCIAL GENERAL LIABILITY CG20011219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: BCS2002162 COMMERCIAL GENERAL LIABILITY CG 25 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally b. Claims made or"suits" brought; or obligated to pay as damages caused by 'occur- c. Persons or organizations making claims or rences" under Section I —Coverage A, and for all bringing "suits". medical expenses caused by accidents under Section I — Coverage C, which can be attributed 3. Any payments made under Coverage A for only to operations at a single designated "loca- damages or under Coverage C for medical tion" shown in the Schedule above: expenses shall reduce the Designated Loca- l. A separate Designated Location General tion General Aggregate Limit for that desig- Aggregate Limit applies to each designated nated "location". Such payments shall not re- "location", and that limit is equal to the duce the General Aggregate Limit shown in amount of the General Aggregate Limit the Declarations nor shall they reduce any shown in the Declarations. other Designated Location General Aggre- gate Limit for any other designated "location" 2. The Designated Location General Aggregate shown in the Schedule above. Limit is the most we will pay for the sum of all 4. The limits shown in the Declarations for Each damages under Coverage A, except damag- Occurrence, Damage To Premises Rented To es because of "bodily injury" or "property You and Medical Expense continue to apply. damage" included in the "products-completed However, instead of being subject to the operations hazard", and for medical expenses General Aggregate Limit shown in the Decla- under Coverage C regardless of the number rations, such limits will be subject to the appli- of: cable Designated Location General Aggre- a. Insureds; gate Limit. CG 25 04 05 09 C Insurance Services Office, Inc., 2008 Pagel of 2 ❑ B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by 'occur- "products-completed operations hazard" is pro- rences" under Section I—Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be at- the "products-completed operations hazard" will tributed only to operations at a single designated reduce the Products-completed Operations Ag- "location" shown in the Schedule above: gregate Limit, and not reduce the General Ag- 1. Any payments made under Coverage A for gregate Limit nor the Designated Location Gen- damages or under Coverage C for medical eral Aggregate Limit. expenses shall reduce the amount available D. For the purposes of this endorsement, the Defi- under the General Aggregate Limit or the nitions Section is amended by the addition of Products-completed Operations Aggregate the following definition: Limit, whichever is applicable; and "Location" means premises involving the same or 2. Such payments shall not reduce any Desig- connecting lots, or premises whose connection is nated Location General Aggregate Limit. interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 04 05 09 ❑ POLICY NUMBER: BCS2002162 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s)shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 975624551 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured:Dominguez General Engineering, Inc. Endorsement Effective Date:06/15/24 SCHEDULE Name Of Person(s) Or Organization(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: 975624551 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DOMINGUEZ GENERAL ENGINEERING, INC. Endorsement Effective Date: 06/15/24 Transaction Date: 06/15/24 SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: 975624551 COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance — Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under such an "insured" under your policy provided that: other insurance; and 1. Such "insured" is a Named Insured under such 2. You have agreed in writing in a contract or other insurance; and agreement that this insurance would be 2. You have agreed in writing in a contract or primary and would not seek contribution from agreement that this insurance would be any other insurance available to such primary and would not seek contribution from "insured". any other insurance available to such "insured". CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY W C 0 4 0 3 0 6 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration o f your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% ofthe California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIYER This endorsement changes the policy to which it is attached and is effective cn the date issued unless otherwise stated (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 10/01/2024 Policy No. 7600024851241 Endorsement No. 001 Insured Dominguez General Engineering, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: ------------------------- -1998 by the Workers' Compensation Insurance Rating Bureau of California.All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual-1999. ENVIRONMENTAL Policy No. CPLMOL124441 NIARM EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM A. Section III —Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you perform or performed"your work" and with whom you have agreed to provide additional insured status in a written contract or agreement,provided the written contract or agreement was executed prior to the: a. Commencement of"your work"; and b. Date the "pollution condition" first commenced. 2. Any other person or organization you are required to add as an additional insured under the written contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage", or"cleanup costs" resulting from a "pollution condition" caused, in whole or in part, by"your work". However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the written contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section IV — Limits Of Insurance And Self-Insured Retention Or Deductible: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or agreement described in Paragraph A.1.; or 2. Available under the applicable limits of insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable limits of insurance shown in the Declarations. All other terms and conditions remain unchanged. MEEI 2906 11 19 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENVIRONMENTAL POLICY NUMBER: CPLMOL124441 FYI R�[Er EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following, where indicated by an"X" in the checkbox(es) below: ❑ COMMERCIAL GENERAL LIABILITY COVERAGE FORM E3 CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM ❑ PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE FORM Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. The following is added to the Transfer Of Rights Of Recovery Against Others To Us condition: Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization with whom the Named Insured has agreed, in a written contract executed prior to the "occurrence" or "pollution condition", to waive such rights of recovery because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract with that person or organization. All other terms and conditions remain unchanged. MEEI 2592 08 191 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Policy No.:660 3X218203 COMMERCIAL INLAND MARINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET LOSS PAYEES This endorsement modifies insurance provided under the COMMERCIAL INLAND MARINE COVERAGE PART The following is added to Section E - ADDITIONAL b. Pay any claim for loss or damage jointly to you COVERAGE CONDITIONS: and the Loss Payee as your interests may Loss Payable Provision appear. In the event of a Covered Cause of Loss to Covered This endorsement applies to all Covered Property for Property in which both you and a Loss Payee share which a Loss Payee is cn file with us or your an insurable interest, we will: insurance agent or insurance broker. a Adjust the loss or damage with you; and CM U618 CS 21 0 2021 The Travelers Indemnity Company Page 1 of 1 Includes copyrighted material of Insurance Services OffiWr Inc.with its pennission.