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HomeMy WebLinkAboutLEGION CONTRACTORS, INC.(OUTDOOR LIBRARY AT JEROME PARK) $Nc:JRANCE ON FILE ". R.If MAY PROCEED UNTIL:N3URANCE EXPIRES I I ( .211,-o CITY OF SANTA ANA CITY Clip CONSTRUCTION CONTRACT AGREEMENT DATE: Ep p 6 2024 P W Cs-) PROJECT NOS.: 22-1381 &25-7523 ( rAc")"" OUTDOOR LIBRARY AT JEROME PARK This CONSTRUCTION CONTRACT is made and entered into this 20th day of August, 2024 by and between the City of Santa Ana,California,a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California(hereinafter"CITY"), and Legion Contractors, Inc. (hereinafter"CONTRACTOR"). WITNESSETH: The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: 1. CONTRACTOR agrees to perform all the work and furnish all the materials at its own cost and expense necessary to construct and complete in a good and workmanlike manner and to the satisfaction of the City Engineer of the CITY, the Outdoor Library at Jerome Park Project(hereinafter referred to as the "WORK OF IMPROVEMENT") identified in and in accordance with the Contract Documents prepared by the City's Public Works Agency and approved by the City Council. 2. The complete Construction Contract consists of the "Contract Documents"as defined by the Standard Specifications for Public Works Construction and which include the following: • Notice Inviting Bids • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Contract Bonds • General Provisions • Special Provisions • Technical Provisions and Project Plans • Community Workforce Agreement • Appendices In case of conflict between the Contract Documents, the precedence of documents shall be as established in the Standard Specifications for Public Works Construction. 3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the WORK OF IMPROVEMENT the sum total amount not to exceed Three Million Three Hundred Thirty Six Thousand Four Hundred Dollars and No Cents($3,336,400.00), as set forth and identified in the BID PROPOSAL,which is attached hereto and incorporated herein as Exhibit"A," and in accordance with Section 2-7.1 of the Greenbook: Standard Specifications for Public Works Construction. The BID PROPOSAL contains a schedule of unit price(s)or lump sum(s) based on approximate quantities only, and the City does not expressly or by implication agree that the actual amount of work will correspond therewith, but reserves the right to increase or decrease the amount of any rev.08/01/2023 Page 1 of 4 class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. 4. CONTRACTOR agrees to complete the WORK OF IMPROVEMENT within the time specified in the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A") including commencing construction within the timeframe therein specified after issuance of a Notice to Proceed. 5. The CONTRACTOR will pay,and will require all subcontractors to pay,all employees on the WORK OF IMPROVEMENT a salary or wage at least equal to the prevailing salary or wage established for such work as set forth in the wage determinations for this work in accordance with applicable State and Federal law. 6. If applicable, the CONTRACTOR shall adhere to the CITY'S Community Workforce Agreement (CWA), a pre-hire collective bargaining agreement,which establishes the labor relations policies and procedures for CONTRACTOR to follow in the crafts persons employed to complete the WORK OF IMPROVEMENT as more fully described in the CWA. The CWA may be found on the City's website at: http://www.santa-ana.org/pwa/documents/CWA.pdf 7. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful performance of the work(Performance Bond),and one in the amount of One Hundred Percent(100%) of the Contract price to guarantee payment of all claims for labor and materials furnished (Payment Bond). This Contract shall not become effective until such bonds are supplied to and approved by the CITY. 8. CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention payment, furnish a warranty performance and payment bond (Warranty Bond). Said Warranty Bond shall also be required as a condition of project acceptance. For projects up to Five Hundred Thousand Dollars($500,000),the Warranty Bond amount shall be the greater of Ten Thousand Dollars($10,000) or Twenty Percent (20%) of the final contract price. For projects above Five Hundred Thousand Dollars($500,000),the Warranty Bond amount shall be the greater of One Hundred Thousand Dollars ($100,000)or Ten Percent(10%) of the final contract price. 9. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions,to be approved by the CITY. 10. INDEMNIFICATION. To the fullest extent allowed by law, CONTRACTOR and its Subcontractors hereby agree to defend, indemnify, and hold harmless CITY, its City Council, boards and commissions, officers, agents, employees, representatives and volunteers (hereinafter collectively referred to as "Indemnitees"), through legal counsel acceptable to CITY, from and against any liability, claims, actions, costs, damages or losses, including reasonable costs and attorney's fees, for injury, including death to any person or damage to any property, arising directly or indirectly from,or in any manner relating to,any of the following: (i) Performance or nonperformance of the Work of Improvement by CONTRACTOR or its Subcontractors of any lower tier; Page 2 of 4 (ii) Performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, of any of the obligations under the Contract Documents; (iii) The construction activities of CONTRACTOR or its Subcontractors of any lower tier, either on the project site or on other properties; (iv) The payment or nonpayment by CONTRACTOR of any of its Subcontractors of any lower tier, for Work of Improvement performed on or off the project site; and (v) Any personal injury, property damage or economic loss to third persons related to and arising from the performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, of the Work of Improvement. (vi) The indemnity obligations of Subcontractors provided by this Section shall be included in all subcontract documents issued by CONTRACTOR. Nothing in the Contract Documents shall be construed to give rise to any implied right of indemnity in favor of CONTRACTOR against CITY or any other Indemnitee. 11. FEDERAL FUNDING REQUIREMENTS. Contractor shall comply, and ensure all subcontractors comply, with all applicable regulations, policies, guidelines and requirements of the Community Development Block Grant (CDBG)program set forth by U.S.Department of Housing and Urban Development for sub-recipients including,without limitation,the funding requirements laid out in Appendix P of the Contract Documents. Contractor's attention is specifically directed to the following, which are each incorporated herein by this reference: (i) 2 CFR Part 200 (Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards). (ii) Program Income—24 CFR Part 570.500(a)(1) (iii) Unused Program Income—24 CFR Part 570.503(b)(3) (iv) Transfers of Program Income—24 CFR Part 570.504(b)(2) (v) Disposition of Program Income—24 CFR Part 570.504(c) (vi) Applicability of Uniform Administrative Requirements—24 CFR § 570.502 (vii) Subpart K of the CDBG Regulations, commencing with 24 CFR§ 570.600 (viii) Section 3 Requirements specified herein. (ix) Federal Contract Provisions specified herein. With respect to any conflict between such federal requirements and the terms of the Contract Documents and/or the provisions of state law and except as otherwise required under federal law or regulation, the more stringent requirement shall control. Contractor shall be subject to the Davis-Bacon Act.The federal minimum wage rates are attached hereto as Appendix 0 of the Contract Documents. When the Davis- Bacon wage rates and California prevailing wage rates differ for similar kinds of labor, the Contractor shall pay not less than the higher rate. Contractor shall additionally comply with the applicable flow down terms and conditions of the CDBG Funding Agreement, which are attached hereto as Exhibit"B", and incorporated herein by reference. Nothing in the Contract Documents shall be construed to give rise to any implied right of indemnity in favor of CONTRACTOR against CITY or any other Indemnitee. [Signatures on the following page] Page 3 of 4 IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: CITY OF SANTA ANA i SMt JENNIFE . HA L ALVARO NUNEZ _ J Cit C - City Manager APPROVED AS TO FORM: SONIA R. CARVALHO CONTRACTOR: City Attorney Legion Contractors, Inc. 711 By: 1;' JOS` MONTOYA NAME:Saba Khoubanshargh Assistant City Attorney TITLE: Secretary&Vice President RECOMMENDED FOR APPROVAL: Nab i l Saba Date:202 08.01Diitally signed b10:10:27 Sabay Nabil -07'00' NABIL SABA, PE Executive Director Public Works Agency Page 4 of 4 Addendum No. 3 EXHIBIT A CITY OF SANTA ANA Project No. 22-1381 PROPOSAL PROJECT NO.: 22-1381 OUTDOOR LIBRARY AT JEROME PARK BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: Legion Contractors, Inc. REQUIREMENT: The undersigned bidder declares that they have carefully examined the location of the proposed work, that they have examined the Contract Documents in its entirety and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans (if any) and the specifications for the unit price(s) or lump sum(s)set forth in the following schedule: Item Description Qty Unit Unit Price Amount 1 Mobilization/Erosion Control 1 LS $ 150,000 $ 150,000 2 Clearing and Grubbing 1 LS $ 80,000 80,000 3 Site Demolition 1 LS S $ 95,000 95,000 4 Grading and Excavations 1 LS $ $ 100,000 100,000 5 Site Drainage 1 LS $ $ 120,000 120,000 6 24-Hour Library and Shelter 1 LS S $ 200,000 200,000 7 Site Electrical and Fiber 1 LS $ $ 315,000 315,000 8 Concrete Slab on Grade 420 SF $ $ 25 10,500 9 Pedestrian Concrete Paving—Bike Play 3,513 SF $ $ Track* 40 140,520 10 6"Wide Flush Concrete Curb* 336 LF $ $ 100 33,600 11 Pedestrian Concrete Paving—Pathways * 16,665 SF $ $ 25 416,625 12 Accessible Concrete Ramps 250 SF S 100 $ 25,000 13 Demonstration Surface—Recycled Concrete 74 SF $ $ Pavers with Aggregate* 250 18,500 14 Pour-in-Place Permeable Pavement— 1,369 SF $ S Filterpave* 50 68,450 P-1 of P-19 Addendum No. 3 CITY OF SANTA ANA Project No. 22-1381 PROPOSAL PROJECT NO.: 22-1381 OUTDOOR LIBRARY AT JEROME PARK Item Description Qty Unit Unit Price Amount 15 Synthetic Safety Surfacing 6,250 SF $ $ 26 162,500 16 Playground Equipment 1 LS $ $185,000 185,000 17 Site Furnishings 1 LS $ $ 300,000 300,000 18 Seat Walls 106 LF $ $1,000 106,000 19 Irrigation System 1 LS $ $ 200,000 200,000 20 Planting 1 LS $ $ 200,000 200,000 21 Landscape Establishment 1 LS $ $ 17,000 17,000 22 Asphalt Pavement 21,600 SF $ $6 129,600 23 Remove and Replace Cross Gutter 460 LF $ $ 200 92,000 24 Signing and Striping 1 LS $ $25,000 25,000 25 Bioretention Basin 1 LS $ $35,000 35,000 26 SWPPP-Risk Level 2 1 LS $ $ 30,000 30,000 27 Construction Permit 1 EA $ 11,700.00 $ 11,700.00 28 Project Advertising Sign 1 EA $ $ 9,405 9,405 Bid Alternates 1 Asphalt Pavement Aggregate Base 200 CY $ 300 $ 60,000 P-2 of P-19 Addendum No. 3 CITY OF SANTA ANA Project No. 22-1381 PROPOSAL PROJECT NO.: 22-1381 OUTDOOR LIBRARY AT JEROME PARK TOTAL BASE BID $ 3,276,400 TOTAL ADD ALTERNATE BID ; 3,336,400 The lowest responsible bidder shall be selected based on the total base bid. The City reserves the right to award the Base Bid, and any,all, or none of the add-alternate bid items (if any). * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the"25%"limit as stated in Section 7-3.5 of the Standard Specifications. The actual amount for this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. f This bid item is considered a Specialty Item per Section 3-2 of the Standard Specifications. TIME FOR COMPLETION OF IMPROVEMENTS AND LIQUIDATED DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within One-Hundred Twenty (120) working days after the commencement date stated in the Notice to Proceed.Upon issuance of the Notice to Proceed, Contractor shall immediately place order for long-lead time items(24-Hour Library Kiosk and Shelter). The liquidated damages amount,in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $4,280 per calendar day. Name of Firm Legion Contractors, Inc. -Corporation Signature of BIDDER Title Saba Khoubanshargh-Secretary&Vice President (If an individual, so state. If a firm or co-partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary,Treasurer and Manager, thereof.) Amir Movafegh-President, Treasurer and Manager P-3 of P-19 Funding Approval/Agreement U.S.Department of Housing and Urban Development EXHIBIT B Title I of the Housing and Community Office of Community Planning and Development Development Act(Public Law 930383) Community Development Block Grant Program OMB Approval No.2506-0193 HI.00515R of20515R exp 1/31/2025 1.Name of Grantee(as shown In item 5 of Standard Form 424) 3a.Grantee's 9-digit Tax ID Number 3b.Grantee's 9-digit DUNS Number Santa Ana 956000785 KZE9G2M4GRX9(UEI) 2.Grantee's Complete Address(as shown in item 5 of Standard Form 424) 4.Date use of funds may begin 20 Civic Center Plaza 07/01/2022 Santa Ana,CA 92701-0000 5a.Project/Grant No.1 6a.Amount Approved B-22-MC-06-0508 $5,088,771 5b.Project/Grant No.2 fib.Amount Approved Grant Agreement: This Grant Agreement between the Department of Housing and Urban Development(HUD)and the above named Grantee is made pursuant to the authority of Title I of the Housing and Community Development Act of 1974,as amended,(42 USC 5301 et seq.).The Grantee's submissions for Title I assistance,the HUD regulations at 24 CFR Part 570(as now in effect and as may be amended from time to time),and this Funding Approval,including any special conditions,constitute part of the Agreement. Subject to the provisions of this Grant Agreement,HUD will make the funding assistance specified here available to the Grantee upon execution of the Agreement by the parties. The funding assistance specified in the Funding Approval may be used to pay costs incurred after the date specified in item 4 above provided the activities to which such costs are related are carried out in compliance with all applicable requirements. Pre-agreement costs may not be paid with funding assistance specified here unless they are authorized in HUD regulations or approved by waiver and listed in the special conditions to the Funding Approval. The Grantee agrees to assume all of the responsibilities for environmental review,decision making,and actions,as specified and required in regulations issued by the Secretary pursuant to Section 104(g)of Title I and published in 24 CFR Part 58. The Grantee further acknowledges its responsibility for adherence to the Agreement by sub- recipient entities to which it makes funding assistance hereunder available. U.S.Department of Housing and Urban Development(By Name) Grantee Name(Contractual Organization) Rufus Washington Santa Ana(City of) Title Title CPD Director City Manager Signature Date(mm/ddtyyyy) Signature Date(mmldd/yyyy) 10/21/2022 x ,- X 7.Category of Title I Assistance for this Funding Action: 8.Special Conditions 9a.Date HUD Received Submission 10.check one (check one) (mm/dd/yyyy) ®a.Orig.Funding Entitlement,Sec 106(b) El None 9b.Date Grantee Notified Approval ®Attached (ram/ddtyyyy) 0 b.Amendment 9c.Date of Start of Program Year Amendment Number 7/1/2022 11.Amount of Community Development Block Grant FY 2022 a.Funds Reserved for this Grantee b.Funds now being Approved $5,088,771 c.Reservation to be Cancelled (11a minus 11b) 12a.Amount of Loan Guarantee Commitment now being Approved 12b.Name and complete Address of Public Agency N/A Loan Guarantee Acceptance Provisions for Designated Agencies: The public agency hereby accepts the Grant Agreement executed by the Department of Housing and Urban Development on the above date with respect to the above grant number(s)as Grantee designated to receive loan 12c.Name of Authorized Official for Designated Public Agency guarantee assistance,and agrees to comply with the terms and conditions of the Agreement,applicable regulations,and other requirements of I-IUD Title now or hereafter in effect,pertaining to the assistance provided it. Signature X HUD Accounting use Only Effective Date Batch TAC Program Y A Reg Area Document No. Project Number Category Amount (mm/dd/yyyy) F 53 1 7 6 Y Project Number Amount Y Pr ' c Amount Date Entered PAS(mm/ddlyyyy) Date Entered LOCCS(mmldd/yyyy) Batch Number Transaction Code Entered By Verified By 24 CFR 570 form HUD-7082(5/15) 8. Special Conditions. (a) The period of performance and single budget period for the funding assistance specified in the Funding Approval ("Funding Assistance") shall each begin on the date specified in item 4 and shall each end on September 1,2029. The Grantee shall not incur any obligations to be paid with such assistance after September 1, 2029. (b) The Recipient shall attach a schedule of its indirect cost rate(s) in the format set forth below to the executed Agreement that is returned to HUD. The Recipient shall provide HUD with a revised schedule when any change is made to the rate(s) described in the schedule. The schedule and any revisions HUD receives from the Recipient shall be incorporated herein and made a part of this Agreement,provided that the rate(s) described comply with 2 CFR part 200, subpart E. Administering Direct Department/Agency Indirect cost rate Cost Base CDA 14.92 % Instructions: The Recipient must identify each agency or department of the Recipient that will carry out activities under the grant, the indirect cost rate applicable to each department/agency (including if the de minimis rate is used per 2 CFR§200.414(f)), and the type of direct cost base to which the rate will be applied (for example, Modified Total Direct Costs(MTDC)). Do not include indirect cost rates for subrecipients. (c) In addition to the conditions contained on form HUD 7082, the grantee shall comply with requirements established by the Office of Management and Budget (OMB) concerning the Dun and Bradstreet Data Universal Numbering System (DUNS); the System for Award Management(SAM.gov.); the Federal Funding Accountability and Transparency Act as provided in 2 CFR part 25,Universal Identifier and General Contractor Registration; and 2 CFR part 170, Reporting Subaward and Executive Compensation Information. (d) The grantee shall ensure that no CDBG funds are used to support any Federal, State,or local projects that seek to use the power of eminent domain, unless eminent domain is employed only for a public use. For the purposes of this requirement, public use shall not be construed to include economic development that primarily benefits private entities. Any use of hinds for mass transit, railroad, airport, seaport or highway projects as well as utility projects which benefit or serve the general public (including energy-related, communication- related, water- related and wastewater-related infrastructure), other structures designated for use by the general public or which have other common-carrier or public-utility functions that serve the general public and are subject to regulation and oversight by the government, and projects for the removal of an immediate threat to public health and safety or brownfield as defined in the Small Business Liability Relief and Brownfields Revitalization Act(Public Law 107-118) shall be considered a public use for purposes of eminent domain. (e) The Grantee or unit of general local government that directly or indirectly receives CDBG funds may not sell, trade, or otherwise transfer all or any such portion of such funds to another such entity in exchange for any other funds, credits or non-Federal considerations, but must use such funds for activities eligible under title I of the Act. (f) E.O. 12372-Special Contract Condition-Notwithstanding any other provision of this agreement, no funds provided under this agreement may be obligated or expended for the planning or construction of water or sewer facilities until receipt of written notification from HUD of the release of funds on completion of the review procedures required under Executive Order(E.O.) 12372, Intergovernmental Review of Federal Programs, and HUD's implementing regulations at 24 CFR Part 52. The recipient shall also complete the review procedures required under E.O. 12372 and 24 CFR Part 52 and receive written notification from HUD of the release of funds before obligating or expending any funds provided under this agreement for any new or revised activity for the planning or construction of water or sewer facilities not previously reviewed under E.O. 12372 and implementing regulations. (g) CDBG funds may not be provided to a for-profit entity pursuant to section 105(a)(17) of the Act unless such activity or project has been evaluated and selected in accordance with Appendix A to 24 CFR 570 - "Guidelines and Objectives for Evaluating Project Costs and Financial Requirements." (Source- P.L. 113-235, Consolidated and Further Continuing Appropriations Act, 2015, Division K, Title II, Community Development Fund). ACoRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY() 8/23/2024 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: charisls Ferqu I • GMGS Risk Manag ent& Insurance services PHONE — I cne�J(,,� by 6201 Oak Can oe (NC.No'ILa t) Irvine, CA 92618 A DRESS: - C e m s.co NSURER S)AFFORDIN OVERAGE NAIL# www.gmgs.com g1j INSURER A CI l�Ur f, C�v e d o 20338 INSURED INSURER : L'ndmark A rican Insurance Company 33138 Legion Contractors, Inc. INSURE C: St. tion I �ju p 35076 445 S. Figueroa Str t, Suite 2580 m • O• �85202 Los Angeles CA 9 1 \I' INSUF.R D: Cr W. I• S OINS'nER E _LIr SURER F: • COVERAGES CERTIFICATE NUMBER: 815667FJ 1 6•42.R6/1610N DA EROV THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW ;,AVE 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ,MM/DD/YYYY) (MM/DD/YYYYL LIMITS A / COMMERCIAL GENERAL LIABILITY CPGLP-00000114 5/12/2024 5/12/2025 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE ✓ OCCUR PREMISES(Ea occurrence) $50,000 MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $2,000,000 POLICY ✓ JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: s A AUTOMOBILE LIABILITY CPBAP-00000115 5/12/2024 5/12/2025 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ,/ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ _ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) $ $ A UMBRELLA LIAB / OCCUR CPLXP-00000116 5/12/2024 5/12/2025 EACH OCCURRENCE $5,000,000 ✓ EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ _ $ C WORKERS COMPENSATION 9264599-23 11/21/2023 11/21/2024 �/ STATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? 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 B Excess Liability-U/L CPLXP-00000116 LHA600422 5/12/2024 5/12/2025 $3,000,000 Each Occ/Agg D Contractors Pollution Liability ENP0011782-01 8/23/2024 8/23/2025 $1,000,000 Each Occ $2,500 Deductible $2,000.000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Outdoor Library at Jerome Park;Project No.22-1381 This certificate may be relied upon only if the certificate addendum referred to herein is attached hereto. CERTIFICATE HOLDER CANCELLATION of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City y of Santa Center Plaza Plaza THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 2ACCORDANCE WITH THE POLICY PRC\ / Santa Ana CA 92701 0,!, s Risk ManagementDiviston AUTHORIZED REPRESENTATIVE <' REVIEWED&APPROVED BY: ,u Pam" A4• a Aca+r 4 G ice', I Paul Bland `— --- Risk Management Specialist ©1988-2015 ACORD / \ ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 81566780 124-25 A G W XS POLL-PP 1 Charise Ferguson 18/23/2024 1:36:48 PM (PDT) I Page 1 of 12 AGENCY CUSTOMER ID: LOC#: Accueco ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED &Insurance Services Legion Contractors,Inc. GMGS Risk Management 445 S.Figueroa Street,Suite 2580 POLICY NUMBER Los Angeles CA 90071 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:Certificate of Liability(03/16) HOLDER:City of Santa Ana ADDRESS:20 Civic Center Plaza Santa Ana CA 92701 RE: Outdoor Library at Jerome Park; Project No. 22-1381 As respects General Liability coverage, City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers are added as Additional Insured, per CG20101219 & CG20371219 attached, and this insurance is primary, per CG20011219 attached. As respects General Liability coverage, a Waiver of Subrogation is hereby included, per CG24041219 attached. As respects General Liability coverage, 30-day written notice of cancellation (10 days for non-payment of premium) applies per IL00171198 attached. As respects Automobile Liability coverage, City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers are added as Additional Insured, per PBA300000422 attached, and this insurance is primary, per CA04491116 attached. As respects Automobile Liability coverage, a Waiver of Subrogation is hereby included, per CA04431120 attached. As respects Automobile Liability coverage, 30-day written notice of cancellation (10 days for non-payment of premium) applies per IL00171198 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included per (form number) attached. g ,o�s Risk Management Division /�� � REVIEWED&APPROVED BY: `�u�fl111' Ai A/4 Risk Management Specialist ACORD 101 (2008/01) ©2008 ACORD 1/ The ACORD name and logo are registered marks of ACORD ADDENDUM 81566780 1 24-25 A G W XS POLL-PP 1 Chariae Ferguson 1 8/23/2024 1:36:48 PM (PDT) 1 Page 2 of 12 Accwc, EVIDENCE OF PROPERTY INSURANCE DAT812M/DD/YY'3/2024 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW.THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST. AGENCY (NONN C .Ext): (949)559-3367 COMPANY GMGS Risk Management& Insurance Services Travelers Property Casualty Co of America 6201 Oak Canyon, Suite 100 One Tower Square Irvine, CA 92618 0584519 www.gmgs.com FAX E-MAIL ANC,No): ADDRESS:Ct)arisef©g gs.com Hartford CT 06183 CODE: I SUB CODE: AGENCY CUSTOMER ID#: _ INSURED LOAN NUMBER POLICY NUMBER Legion Contractors, Inc. QT-660-A045248A-TIL-24 445 S. Figueroa Street, Suite 2580 EFFECTIVE DATE EXPIRATION DATE Los Angeles CA 90071 CONTINUED UNTIL 9/15/2024 9/15/2025 I TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATION/DESCRIPTION Outdoor Library at Jerome Park 2115 W McFadden Ave,Santa Ana,CA,92704 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 EVIDENCE OF PROPERTY INSURANCE 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. COVERAGE INFORMATION PERILS INSURED BASIC BROAD ✓ SPECIAL COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE Builders Risk,Replacement Cost,No Coinsurance Limit of Insurance: $3,336,400 $5,000 Job Site Location: 2115 W McFadden Ave,Santa Ana CA 92704 Temporary Storage: $500,000 $5,000 Transit: $500,000 $5,000 REMARKS(Including Special Conditions) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST NAME AND ADDRESS ADDITIONAL INSURED LENDER'S LOSS PAYABLE vi LOSS PAYEE MORTGAGEE City of Santa Ana LOAN# 20 Civic Center Plaza a x. Santa Ana CA 92701 , < Risk Management DEvistort AUTHORIZED REPRESENTATIVE f ��� ',� REVIEWED&APPROVED BY: A Aceuacio • Risk Managementp Paul BlandSpecialist ACORD 27(2016/03) ©1993-2015 ACORD I/ The ACORD name and logo are registered marks of ACORD 8150-6893 124-25 Hldrs Risk I Charise Ferguson 18/23/2024 1.42:23 PM (PDT) 1 Page 1 of 1 Legion Contractors, Inc. POLICY NUMBER: CPGLP_00000114 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 Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy 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 injury" or damage" or "personal and advertising injury" "property damage" occurring after: 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. RIAManagentenEDhiston e REVIEWEDAPPROVED& BY: nq Risk Management Specialist CG 20 10 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 81566780 124-25 A G W XS POLL-PP 1 Charise Ferguson 1 B/23/2024 1:36:48 PM (PDT) 1 Page 3 of 12 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 / o„as•,t,s Risk Management Division ;.�' REVIEWED&APPROVED BY: Aizit Aav �. Risk Management Specialist / \ Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 20 10 12 19 81566780 1 24-25 A G W XS POLL-PP 1 Charise Ferguson 1 8/23/2024 1:36:48 PM (POT) 1 Page 4 of 12 5 POLICY NUMBER: CPGLP-00000114 Legion Contractors,Inc. 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 Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy 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 1. Required by the contract or agreement; or in the "products-completed operations hazard". However: 2. Available under the applicable limits of insurance; 1. The insurance afforded to such additional 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. / Risk Management Division(� _ REVIEWED&APPROVED BY: E. iginilla Risk Management Specialist\ / CG 20 37 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 81566780 124-25 A G W XS POLL-PP 1 Charise Ferguson 1 8/23/2024 1:36:48 PM (PDT) 1 Page 5 of 12 Legion Contractors,Inc. 05/12/2024 CPGLP-00000114 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 (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 ^ �s Risk MansgematEDivis(on `lt� •�d c. REVIEWED E.APPROVED BY: /1416ZZ A Risk Management Specialist CG 20 01 1219 ©Insurance Services Office, Inc., 2018 Page 1 of 1 81566780 124-25 A G W XS POLL-PP 1 Charise Ferguson 18/23/2024 1:36:48 PM (POT) 1 Page 6 of 12 Legion Contractors,Inc. POLICY NUMBER:cPGLP-oo0o0114 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): Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy and any other person or organization you are required to add as an additional insured under such contract or agreement 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. 3 �e Risk Mansgare nLDiviaton REVIEWED&APPROVED BY: 1< 114,eig Accvco1.o Risk Management Specialist ` CG 24 04 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 81566780 124-25 A G W XS POLL-PP 1 Charise Ferguson 18/23/2024 1:36:48 PM (PDT) 1 Page 7 of 12 IL001711 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation b. Give you reports on the conditions we find; 1. The first Named Insured shown in the Declara- and tions may cancel this policy by mailing or deliv- c. Recommend changes. ering to us advance written notice of cancella- 2. We are not obligated to make any inspections, tion. surveys, reports or recommendations and any 2. We may cancel this policy by mailing or deliver- such actions we do undertake relate only to fin- ing to the first Named Insured written notice of surability and the premiums to be charged. We cancellation at least: do not make safety inspections. We do not un- a. 10 days before the effective date of cancel- organization to perform the duty of any person or lation if we cancel for nonpayment of premi- organization to provide for the health or safety urn; or of workers or the public. And we do not warrant that conditions: b. 30 days before the effective date of cancel- a. Are safe or healthful; or lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last mailing address known to standards. us. 3. Paragraphs 1. and 2. of this condition apply not 4. Notice of cancellation will state the effective only to us, but also to any rating, advisory, rate date of cancellation. The policy period will end service or similar organization which makes in- on that date. surance inspections, surveys, reports or rec- ommendations. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we 4. Paragraph 2. of this condition does not apply to cancel, the refund will be pro rata. If the first any inspections, surveys, reports or recom- Named Insured cancels, the refund may be mendations we may make relative to certifica- less than pro rata. The cancellation will be of tion, under state or municipal statutes, ordi- fective even if we have not made or offered a nances or regulations, of boilers, pressure ves- refund. sels or elevators. 6. If notice is mailed, proof of mailing will be suffi- E. Premiums cient proof of notice. The first Named Insured shown in the Declara- B. Changes tions: This policy contains all the agreements between 1• Is responsible for the payment of all premiums; you and us concerning the insurance afforded. and The first Named Insured shown in the Declarations 2. Will be the payee for any return premiums we is authorized to make changes in the terms of this pay. policy with our consent. This policy's terms can be F. Transfer Of Your Rights And Duties Under This amended or waived only by endorsement issued Policy by us and made a part of this policy. Your rights and duties under this policy may not be C. Examination Of Your Books And Records transferred without our written consent except in We may examine and audit your books and rec- the case of death of an individual named insured. ords as they relate to this policy at any time during If you die, your rights and duties will be transferred the policy period and up to three years afterward. to your legal representative but only while acting D. Inspections And Surveys within the scope of duties as your legal representa- 1. We have the right to: tive. Until your legal representative is appointed, anyone having proper temporary custody of your a. Make inspections and surveys at any time; property will have your rights and duties but only with respect to that property. \ T det-rta. Risk�✓MsLo n %' Pp REVIEWED&APPROVED BY: Risk Management Specialist IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 81566780 124-25 A G W XS POLL-PP 1 Marl-Se Ferguson 18/23/2024 1:36:48 PM (POT) 1 Page 8 of 12 Legion Contractors,Inc. CPBAP-00000115 AUTOMATIC ADDITIONAL INSURED The following is added to SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured: d. Any person or organization that you are required to include as an additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who is An Insured provision contained in Section II. Risk nanagcntettnivision REVIEWED&APPROVED BY: Ramalm— Risk Management Specialist Page 1 of 1 81566780 129-25 A G W XS POLL-PP I Charise Ferguson 18/23/2024 1.36:48 PM (POT) 1 Page 9 of 12 Legion Contractors,Inc. CPBAP-00000115 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 an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such 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". Risk Managanate D[vis[on REVIEWED&APPROVED BY: ` . AGevaal Risk Management Specialist CA 04 49 11 16 ©Insurance Services Office, Inc., 2016 Page 1 of 1 B1566780 124-25 A G W XS POLL-PP 1 Cnarise Ferguson 1 B/23/2024 1:36:48 PM (PDT) 1 Page 10 of 12 CPGLP-00000114 COMMERCIAL AUTO Legion Contractors,Inc. CA 04 43 11 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT 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. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to any person(s) or organization(s) for whom you are required to waive subrogation with respect to the coverage provided under this Coverage Form, but only to the extent that subrogation is waived: A. Under a written contact or agreement with such person(s)or organization(s); and B. Prior to the "accident" or the"loss." 4�,``,,an�ca. EA Management Dtvislcm EWED II Ifll i � REVI &APPROVED By: Aavd. CA 04 43 11 20 © Insurance Services Office, Inc., 2019 -. Risk Management Specialist 81566780 1 24-25 A G W XS POLL-PP 1 Charise Ferguson 1 8/23/2024 1,35:48 PM (POT) 1 Page 11 of 12 ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION COMPENSATION INSURANCE BLANKET BASIS 9264599-23 FUND RENEWAL NF HOME OFFICE 8-55-97-01 SAN FRANCISCO EFFECTIVE NOVEMBER 21 , 2023 AT 12 . 01 A.M. PAGE 1 OF 1 AND EXPIRING NOVEMBER 21 , 2024 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME LEGION CONTRACTORS INC 18008 SKY PARK CIR STE 290 IRVINE , CA 92614 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHGI I RF HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEN\ / �s Risk Management Division LIMITATIONS IN THIS ENDORSEMENT. REVIEWED&APPROVED BY: A tlav COUNTERSIGNED AND ISSUED AT SAN(/4FRFRANCISCO: NOVEMBER 22 , 2023 ® Risk Management Specialist (/tea �.H aC'� f e�.�uti 81s24A0�{G24-2s A e xs PoAWTH10RIZED REPRESENT MVE 1:36:48 PM (PDT) I Page 12 of 12 PRESIDENT AND CEO SCIF FORM 10217 IREV.4.20181 OLD DP 217