Loading...
HomeMy WebLinkAboutMARK THOMAS & COMPANY, INC. (5)A-2021-018-02 n MAYOR Valerie AmeZCua MAYOR PRO TEM Thai Viet Phan COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES q I is 1z0z� CITY CLE@YO DATE: FtB 2 5 2025 VW A Cz (L-itk)00� CITY OF SANTA ANA CaS1rx\ko)nvr' Mark Thomas & Company, Inc. Attn: Darin Johnson/Paul Martin 2121 Alton Parkway, Ste. 210 Irvine, CA 92606 PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 W .santa-anaxrc January 27, 2025 CITY MANAGER Alvaro Nuriez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Re: Second and Final Extension to Agreement (#A-2021-018) to Provide Engineering Consulting Services for the Standard Avenue Protected Bike Lane Project Pursuant to Section 3 ("Term") ofthe above referenced Agreement, entered into between Mark Thomas & Company, Inc. and the City of Santa Ana, dated February 2, 2021, the parties hereby agree to further extend the term of the Agreement through February 1, 2026. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely , ,a 4k Nabil Saba, PE l7—Executive Director, Public Works Agency CITY OF S TA ANA Alvaro Nunez City Manager APPROVED AS TO FORM K Nellesen Assistant City Attorney ATTEST PM _ CONSULTANT a� Darin Johnson Principal Engineer SANTA ANA CITY COUNCIL Valerie Amezcua Thai Viet Pban Benjamin Vazquez Jessie Lopez Phil Bacems JopnaNan Ryan Hemandez Mayor Mayor Pm Tam, Wartl t Were! 2 Wars! 3 Ward4 Ward5 varomeunsia tohaMAsame-ana am bvazouezralsime ana one assishopezUsanta-aria om Pbacenar@sanla-ana.om enhemandazfilsenta-ana om Naid Penal.. Ward 6 d 1 MAKK IHU-U7 SUMMA R DATE 11/25/2024Y) 11/25/2024 ,d►�co�Ro 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 License # OE67768 NOAAJACT Jessica McDonald IOA Insurance Services 3875 Hopyard Road Suite 200 Pleasanton, CA 94588 PHONE FAX Alc, No, E,d): (925) 918-4535 (a/c, No): AbmA,'Ess. Jessica.McDonald@ioausa.com INSURER $ AFFORDING COVERAGE NAIL a INSURER A: Continental Casualty Company 20443 INSURED INSURER a: The Continental Insurance Company 35289 INSURER C;Valley Force Insurance Company 20508 Mark Thomas & Company, Inc. INSURER D : 2833 Junction Avenue, Ste 110 San Jose, CA 95134 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDINSp SUER WVD POLICY NUMBER POLICY EFF POLICY UPLTR CL LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X 7040185059 9/15/2024 9115/2025 ENCE $ 1,000,000 NTPIREMI 'EDD num 1 000 goone arson 15,000V $ lOCCURRENCE INJURY 11000,000GEN'L AGGREGATE LIMITAPPLIES PER: LOC EGATE 2,000,000POLICY MP/OP AGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea amitlmu 1,000,000 BODILY INJURY Par arson X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUpT�OpSyyNEp X X 7040183912 9/15/2024 9/15/2025 BODILY WJURV Per accident AUTOS ONLY AIfrOS ONLY Pe�acciRtlenl DAMAGE $ B UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 9,000,000 X EXCESS LIAB X CLAIMS -MADE 7040283234 9115/2024 9/15/2025 AGGREGATE 91000,000 DED RETENTION$ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEIVEXECUTIVE YIN 1MandEWMEatmy n NH) EXCLUDED' Ryyes, describe under DESCRIP ION OF OPERATIONS below NIA X 740274825 9/15/2024 9/1512025 X I PER OTH- STATUTE E E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYE $ 1,000,000 E.L DISEASE- POLICY LIMB 1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) IR-21101 - Santa Ana- Standard Avenue Protected Bike Lanes Project City of Santa Ana, Its City Council, officers, officials, employees, authorized agents, and authorized designated volunteers are included as Additional Insured on a Primary & Non -Contributory basis with Waiver of Subrogation with respects to the General & Auto Liability policies, as required by written contract. Worker's Compensation: Waiver of Subrogation is in favor of City of Santa Ana, its City Council, officers, officials, employees, authorized agents, and authorized designated volunteers, as required by written contract. The Workers Compensation / Employers Liability Deductible is none. 30-day notice of cancellation is included per the policy provisions. APPROVES CERTIFICATE HOLDER CANCEL By Cynthia Mora at 7:34 am, Jan=14-2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Santa AnalSanta Ana-- CA 92702 20 Civic Center Plaza ACORD 25 (2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A� a CERTIFICATE OF LIABILITY INSURANCE DATE(m) Ml2024 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 Design Professionals Insurance Services, LLC Assure t. Diablo Mt. Diablo Blvd Suite 230 Lafayette CA 94549 Lafayette CONTACT NAME: Mandy GUO PHDNE 510-272-1402 FAX No : E-MAIL Do Ess: CertsDesi nPro AssuredPartners.com INSURERS AFFORDING COVERAGE NAICR INSURER A: XL Specialty Insurance Co. 37885 Lice se :6003745 INSURED MARKTHO-03 INSURER B: Mark Thomas & Company, Inc. 2833 Junction Avenue, Suite 110 INSURER C: INSURER D: San Jose CA 95134 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 1830599688 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. LTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICYNUMBER MMIDDYEFF MM/DDT LIMITS COMMERCIAL GENERAL LIABILITY El OCCUR EACH OCCURRENCE $ T RE TED 7ANITUECLAIMS-MADE PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC 7 LOG OTHER: GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accldent $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACHOCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOWPARTNEWEXECUTIVE ❑ OFFICERIMEMBEREXCLUDEDP (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - FA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ A Professional Liability& Contr. Pollution Llab Included DPR6031067 7/1/2024 7/1/2025 Par Claim Aggregate Limit $2,000,000 $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Job Number: 23-00056 - Santa Ana - On -Call Engineering Services. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988-2015 ACORD CORPORATION. All ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DNA Workers Compensation And Employers Liability Insurance Policy Endorsement This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. CA Policy # 7 40274825 All Other States Policy # 7040185157 Form No: G-19160-B 111-1997) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 9; Page: 1 of 1 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 0 Copyright CNA All Rights Reserved CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHOM THE NAMED INSURED HAS AGREED IN WRITING IN A CONTRACT OR AGREEMENT TO WAIVE SUCH RIGHTS OF RECOVERY, BUT ONLY IF SUCH CONTRACT OR AGREEMENT: 1. IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS 2. WAS EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE ADVERTISING INJURY GIVING RISE TO THE CLAIM. COVERAGE PART; AND OR PERSONAL AND (Information required to complete this Schedule, If not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work included in the products -completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and Is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (10-16) Page 1 of 1 VALLEY FORGE INSURANCE COMPANY Insured Name: MARK THOMAS & COMPANY, INC. Policy No: 7040185059 Endorsement No: 20 Effective Date: 09/15/2024 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance services Office, Inc., with its permission. CNA CNA PARAMOUNT Primary and Noncontributory - Other Insurance Condition Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART It Is understood and agreed that the condition entitled Other Insurance is amended to add the following: Primary And Noncontributory Insurance Notwithstanding anything to the contrary, this insurance Is primary to and will not seek contribution from any other Insurance available to an additional Insured under this policy provided that: a. the additional insured Is a named insured under such other insurance; and b. the Named Insured has 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 other terms and conditions of the Policy remain unchanged. This endorsement, which forms apart of and is for attachment to the Policy Issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA74987XX (1-15) Poiicy No: 7040185059 Page 1 of 1 Endorsement No: 17 VALLEY FORGE INSURANCE COMPANY Effective Date: 09/15/2024 Insured Name: MARK THOMAS & COMPANY, INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED Is amended to Include as an Insured any person or organization whom you are required by written contract to add as an additional Insured on this coverage part, but only with respect to liability for bodily Injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily Injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional Insured such coverage; and 2. this coverage part provides such coverage. It. But If the written contract requires: A. additional Insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional Insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional Insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. I. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional Insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The Insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2, supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional Insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage Page 1 of 2 VALLEY FORGE INSURANCE COMPANY Insured Name: MARK THOMAS & COMPANY, INC. Pollcy No: 7040185059 dorsement No: 15 Effective Date: 0 9/ 15 / 2 0 2 4 Copynght CNA All nights Reserved. Includes copyrighted material of Insurance services Office, Inc., with its pe"issbn. CNA CNA PARAMOUNT /�+� Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured Is a named insured, this insurance is primary to and will not seek contribution from such other Insurance, provided that a written contract requires the insurance provided by this policy to be: 1, primary and non-contributing with other insurance available to the additional Insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other Insurance available to the additional insured. A. Solely with respect to the Insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional Insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer In the Investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other Insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3, does not apply to Insurance on which the additional Insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently In effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy Issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (10-16) Policy No: 7040185059 Page 2 of 2 Endorsement No: 15 VALLEY FORGE INSURANCE COMPANY Effective Date: 09/15/2024 Insured Name: MARK THOMAS & COMPANY, INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Business Auto Policy CNAPolicy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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: MARK THOMAS & COMPANY, INC. 0 ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS. Information 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. Form No: CA 04 44 10 13 it Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 4; Page: 1 of 1 1 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 ® Copyright Insurance Services Office, Inc., 2011 N� Business Auto Policy Policy Endorsement It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Person Or Organization ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident' for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA71527XX (10-2012) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 15; Page: 1 of 1 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 ® r..e...:..6. Ohl All D:.! ­ D...........A