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HomeMy WebLinkAboutKDC SYSTEMS (3)MAYOR Valerie Amezcua MAYOR PRO TEM Thai Met Phan COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez INSURANCE ON FILE WORK MAY PROCEED UNTIL INSIU Ai (E Ej�91RES CITY CLERK l I� DATE: MAR 0 6 2025 CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.orn n ; w Gv KDC Systems al(( (n �,,,,it,4r461. Corporate Center Drive Los Alamitos, CA 90720 Attn: Ed Kazimierski, General Manager January 22, 2025 CITY MANAGER Alvaro NuAez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L Hall Re: Extension of Agreement (A-2022-009-01) for On Call Industrial Control Panel Construction Pursuant to Section 3 ("Tenn") of the above -referenced Agreement, entered into by KDC Systems, and the City of Santa Ana, dated January 18, 2022 the time period of the Agreement is hereby extended for an additional two-year period from January 18, 2025 through January 17, 2027. 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, &J�7 �h Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA )I )% err,_ t'J Alvaro Nuflez City Manager APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney lWe Nellesen Assistant City Attorney ATTEST SANTA ANA CITY COUNCIL Vaiena Amamia TRL Vet Pnan 9erp.— Va.q e: ;afua Lo"z Pn1 Eau" Johnntlhan Ryan Hen w4az Cam Pe 10" Yayw kayo, Pro Tam W W I At 0 2 'l:rC 3 .1&-d l Wa'd S Wall 6 varnncrA ante-ana ota I uo oro ptant+emandeziSfanU av oy dhenanra:. mnwa oru AC Rk® CERTIFICATE OF LIABILITY INSURANCE DQzEJMMiD JYYYY) 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 -MARSH USA LLC 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 Phone:866-066-4664 CONTACT PHONE FAX A1c No : EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL # Emcor.CeHmquest@marsh,eom 1 Fax: 203-229-6787 INSURER A: ConlineniO Casualty Company 20443 C14102796740-KDGGAWU-24-25 INSURED KDC INC INSURER B ; American Casualty Companyof Reading, PA 20427 INSURER c : Tran Co 20494 4462 CORPORATE CENTER DRIVE LOS ALAMITOS, CA 90720 INSURER D : Cpnlinertal Insurance Company352B9 INSURER E : - INSURER F : COVERAGES CERTIFICATE NUMBER: NYC n191A9757-n9 RFVISInN NIIMRFR• e 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. ILSR TYPE OFINSVRANCE AIPJSD DDLSUBR POLICYNUMBER POLDIpYYy MMIDDPOLICmYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X� OCCUR GL 7092778897 1010112024 10/01/2026 EACH OCCURRENCE $ 12,00000 DAMAUL I O RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 12,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY M F@C' LOC GENERAL AGGREGATE $ 14,000,000 - PRODUCTS -COMPlOPAGG $ 14,000,000 $ OTHER: A AUTOMOBILELIABILITY BUA 7092778902 10/01/2024 IOIQ112025 co ecolde�tSINGLE LIMIT $ 12,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULEDBODILY AUTOS ONLY AUTOS X NON -OWNED AUTOS ONLY AUTOS ONLY Ix INJURY Peraccidenl ( )HIRED $ PROPERTY DAMAGE Per accident $ Auto Physical Damage $ Included UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB - CLAIMS -MADE DEb I I RETENTION $ $ B D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIInTOWPARTNEwEXECUTIVE YIN OFFICERIMEMBERFXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N ! A WC 7 92781590 (AOS) WC 7 92783954 (CA) WC 7 92798289 (AZ, DR, WI) 10/01/2024 10/0/2D24 1D10112024 10/01/2026 101D112C25 10101/2025 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 - E.L. DISEASE - EA EMPLOYEE $ 1,00,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: ALL OPERATIONS. Tu TrannT ;9 ADDITIONAL INSURED UNDER ALL POLICIES (FXCEPT WORKERS COMPENSATION & EMPLOYERS LIABILITY) WHERE REQUIRED BY CONTRACT: CITY OF SANTA ANA, ITS OFHCER%guye oat r� EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES. n �000i oe WHERE REQUIRED BY CONTRACT, COVERAGE PROVIDED TO THE ADDITIONAL INSUREDS IS PRIMARY & NON-CONTRIBUTORY. WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT AND WHERE NOT PROHIBITED BY LAW. APPROVED CERTIFICATE HOLDER CANCELLATION y Tu Tian Nguyen al} i 59,am, Feb 25, 2025 CITY OF SANTA ANA -WATER RESOURCES DIVISION 220 S DAISY AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE of Marsh USA LLC @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 _� l 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 02/24/2025 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 Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd P.O. Sox 305191 CONTACT WTW Certificate Center NAME: PHONE 1-877-945-1378 FAX 1-688-467-2378 AIC No E-MAIL certificates@wtweo.eom ADDRESS: INSURERS AFFORDING COVERAGE NAIC4 Nashville, TN 372305191 USA INSURER A: Berkley Assurance Company 39462 INSURED ID)C Inc., dba Dynalectric L.A. 4462 Corporate Center Drive INSURER B : INSURER C : Los Alamitos, CA 90720 INSURERD: INSURER E : INSURERF: rrsrnfconi±ec nlrllulnCIP• W37844940 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 ❑ESCRI13ED 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 INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY MMILICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ CLAIMS -MADE OCCUR CA PREMISi Sp a oNccu D nae $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PI~R: GENERAL AGGREGATE $ PRODUCTS $ POLICY ❑ JET LOG $ OTHER: AUTOMOBILE LIABILITY CE Ee aocideolSINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per acoldenl) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROTY DAMAGE Per acciPERdent $ UMBRELLALIAB EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DELI RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y❑ STATUTE ERA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBEREXCLUDED7 (Mandatory In NH) N 1 A E.L. DISEASE - POLICY LIMIT $ If yes, describe undar DESCRIPTION OF OPERATIONS below A Professional Liability Y PCAB-5026259-1024 10/31/2024 10/31/2025 Per Claim $5,000,000 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached Ifrnare space is required) Description: All Operations Waiver of Subrogation applies in favor of Certificate Holder with respects to Professional Liability. APPROVED By Tu Tran Ngruyerr at 7:5s amfeb 25t2025, l+GDTICIP-ATC L7fll ncu CONCF_L Y+ri "'" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana - Water Resources Division AUTHORIZED REPRESENTATIVE 220 S Daisy Ave RFP: 21-100 Santa Ana, CA 92701 CJ 79WI-1U76 AGUKU GUKrUKA I iuN. Ali rignts reserves. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD sn 11): 27330774 BATCH: 3845109 Berkley Assurance Company Page 1 of 1 Responsible Entity Waiver of Subrogation Affirmation Endorsement In consideration of the premium paid, it is understood and agreed that Section XI.C. is deleted in its entirety and replaced with the following: C. Subrogation In the event of any payment under this Policy, we shall be subrogated to all of your rights of recovery thereof. You shall execute and deliver all requested instruments and papers in furtherance of such rights to us and do whatever else is reasonably necessary to secure such rights. You shall do nothing to waive or prejudice such rights. We shall have priority in any recovery, and any amounts recovered in excess of our total payment and the cost to us of recovery shall be paid to you. However, we waive our rights of subrogation under this Policy, to the extent such a waiver is required by a written contractwith you executed priorto the Claim, against any of the following that is not a Responsible Entity: your clients, their parents or other affiliates, and your client's designees; and your co -participants in an entity for which your participation is insured under Definition 0.4. of this Policy. For Coverage A only, we will not subrogate against a Responsible Entity, provided it has maintained Recoverable Insurance, regardless of whether or not such Recoverable Insurance is exhausted or reduced. Whenever printed in this Endorsement, the boldface type terms shall have the same meanings as indicated in the Policy Form. All other provisions of the Policy remain unchanged. Insured Number EMCORGroup, Inc TPolicy CAB-5026259-1024 Effective Date of This Endorsement P�U-thorized Representative 10/31/2024 Policy Form: PERFORM-10002 (11-20) 37489-5021542-132351 23 - PERFORM-10118 (01-21) AGENCY CUSTOMER ID: GN102796740 LOC #: New York A O ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY —MARSH USA LLC NAMED INSURED KDC INC 4462 CORPORATE CENTER DRIVE LOS ALAMITOS, CA 90720 POLICY NUMBER 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. Insurance AUTO PHYSICAL DAMAGE COMP I COLL DEDUCTIBLE $500 FOR WORKER'S COMPENSATION, AUTO LIABILITY, GENERAL UABILITY AND UMBRELLA LIABILITY, IN THE EVENT OF CANCELLATION OR MATERIAL CHANGE THAT REDUCES OR RESTRICTS THE INSURANCE AFFORDED BY THIS COVERAGE PART (OTHER THAN THE REDUCTION OF AGGREGATE LIMITS THROUGH PAYMENT OF CLAIMS AS APPLICABLE), INSURER AGREES TO MAIL PRIOR WRITTEN NOTICE OF CANCELLATION OR MATERIAL CHANGE TO; CERTIFICATE HOLDER SCHEDULE 1, NUMBER OF DAYS ADVANCE NOTICE; FOR ANY STATUTORILY PERMITTED REASON OTHER THAN NON-PAYMENT OF PREMIUM, THE. NUMBER OF DAYS REQUIRED FOR NOTICE OF CANCELLATION AS PROVIDED IN PARAGRAPH 2 OF EITHER THE CANCELLATION COMMON POLICY CONDITIONS OR AS AMENDED BY THE APPLICABLE STATE CANCELLATION ENDORSEMENT IS INCREASED TO THE LESSER OF 60 DAYS OR THE NUMBER OF DAYS REQUIRED IN A WRITTEN CONTRACT. FOR NON-PAYMENT OF PREMIUM, THE GREATER OF (1) THE NUMBER OF DAYS REQUIRED BY STATE LAWOR (2) THE NUMBER OF DAYS REQUIRED BY WRITTEN CONTRACT. 2. NAME; NOTICE WILL BE MAILEO TO: CERTIFICATE HOLDER ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD G-300703-A (Ed. 05/09) POLICY NUMBER: GL 709277.0897 NAMED INSURED: EMCOR GROUP, INC. POLICY TERM, 10I0.1/2024 to 10/01/2025 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE PRIMARY AND NON-CONTRIBUTORY This endorsement mod€fles insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FART Paragraph a. Primary Insurance of 4, Other Insurance of Section IV. Commercial General Liability Conditions is deleted and replaced with the following: a. Primary insurance This Insurance is primary except when Paragraph b: below applies. If this Insurance is primary, our obligations are not affected unless any of the. other Insurance 1s also primary. Then, we will share with all that :other insurance by the method described in. Paragraph c. below. However, coverage afforded to an additional insured under the terms of an endorsement attached to this policy is primary Insurance and we will not seek contributlon from any .such additional In.sured's primary insurance If: (1) You haveagreed in writing In a contract or agreement that; this Insurance will be. primary and noncontributory; and (2) The written contract or written agreement was executed prior to: (a) The "bodily Injury" or "property damage"; or (b) The offense that caused the "personal and advertising injury" for which the additional insured seeks coverage under this Coverage Part. G-300703-A Includes copyrighted Material of Insurance Services Office, Inc., with Its permission, Page i of 1. (Ed. 05109) POLICY NUMBER; GL 7092778097 NAMED.INSURED: EMCOR Group,. Inc. POLICY TERM- 10-01-2024 to 10-01-2025 CG 2010 10 93 THIS ENDORSEMENT CHANGESTHE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL IONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM By This andorsernent modifies insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE.PA.RT SCHEDULE Name of .Person or Organization, ALL PERSONS OR ORGANIZATIONS' FOR WHOM YOU ARE REQUIRED BY CONTRACT TO ADD AS AN AbDITIONAL INSURED BUT ONLY IF THE PER$ON Old ORGANIZATEON DOES .NOT QUALIFY As AN ADDITIONAL INSURED WITH RESPECT TO WORK PERFORMED BY OR FOR YOU PURSUANT TO THAT CONTRACT OR ANOTHER ADDITIONAL INSURED ENDORSEMENT ATTACHED TO AND FORMING A PART OF THIS POLICY (If no entry appears above, information, required to complete this endorsement will be .shown. in.the beclarotions as ap- plicable to this endorsement.) WHO IS AN INSURED (Section ll) is amended to. Include as .an insured the person,or organization shown in the Sched- ule, but only with respect to liability arising out of your ongoing operations performed for that: insured. Hwt Forms & 6orvtces Reorder No, i4.8737 CG 20 1010 93 Copyright, Insurance Services Office, Inc., 1092 pogo 1 of 'I POLICY NUM13ER: GL 7092778897 NAMED INSURED; EMOOR Group, Inc. POLICY TEFiM: 10-01 -2024 to 10-01-2025 COMMERCIAL GENERAL LIABILITY CO 20 37.07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE DEAD IT CAREFULLY, ADDITIONAL INSURER — OWNERS, LESSEES OR CONTRACTORS RS — COMPLETED OPERATIONS This endorsement modifies insurance prided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Person($) SCHEDULE PERSONS OR ORGANIZATIONS FOR WHOM YOU ARE REQUIRED BY CONTRACT TO ADD AS AN ADDITIONAL INSURED FOR COMPLETED OPERATIONS COVERAQE BUT ONLY IF THE PERSON ORORGANIZATION DOES NOT QUALIFY AS AN. ADDTIONAL INSURED FOR COMPLETED OPERATIONS ON ANOTHER ADDITIONAL INSURED ENDORSEMENT ATTACHED TO AND FORMING A PART OF THIS POLICY. AS PER THE WRITTEN CONTRACT OR WRITTEN AGREEM9NT, PROVIDED THE LOCATION IE WITHIN THE'COVERAGE TERRITORY" OF THIS COVERAGE PART. Information rroqulred_to complete this Schedulo, If not shown above, rail be shown In the Decieratlorns. -1 Seat * n II Who Is An .lnouro0 Is amended 10 Include as .an additional insured the porson(s) or organization(s) shown In the Schedules but only with raepsdt to liability for "bodily Injurr.or "property dem- agi caused. In whole or in part, by -your woprle at the location designated and described Iri the sch.ed- uls of this endorsement perforrm+ad for that additionial Insured grid Included in the "pioducts-completed operations herd„. CO 20 37 07 04 0 ISO Properties, Inc., 2.004 Page I of 1 13 POLICY NUMBER: GL 7002778897 NAMED INSURED.: EMCOR Group, Inc. POLICY TERM; 10.01-20.24 to 10-01w.2Q25 COMMERCIAL GENERAL LIABILITY C.0 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST T OTHERS TO U This endorsement modifies Insurance provided under the .following.: COMMERCIAL GENERAL UABILITY COVERAGE PART PRODIJCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WITH WHOM YOU AGREE UDDER A CONTRACT TO WAIVE YOUR RIGHT TO RECOVER AGAINST THEM. YOU. MUST AGREE TO THIS WAIVER PRIOR TO THE. DATE OF LOSS'. Information required to eom fete 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 we, may have against the person or organization shown in the Schedule above because of payments we snake far Injury or damage arising out of your ongoing operations or "Your .Wark done under a contract with. that person or organization and Included in the "products -completed operations hazard Thls waiver applies only to the person or organization shown in the Schedule above.. CG 24 04 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: I.BUA7092770902 COMMERCIAL AUTO CA04440.310 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: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM' TRUCKERS 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: EMCOR Group, Inc. Endorsement Effective Date: 10/01/2024 SCHEDULE. Name(s) Of Parson(s) Or OrganlZatl0h(8): ANY PERSON OR ORGANIZATION ON WHOSE BEHALF YOU ARE REQUIRED TO OBTAIN THIS WAIVER OF OUR RIGHT TO RECOVER FROM UNDER A CONTRACT OR AGREErMENT. Information required to complete this Schedule, If not shown above, will be shown in.tho Declarations, The Transfer Of Rights Of Recovery Against Others To Its Condition does not apply to the person(s) or organizations) shown in the. Schedule, but only to the extent that subrogation is walveid prior to the "accident" or the "Ions" under a contract with that person or organization. .CA 04 44 0310 Copyright, insurance Services Office., Inc., 2009 Page 1 of I 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. Form No: G-191MB 111-1997) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: ; Page: 1 of 1 Policy No: WC 7 927830U Policy Effective Deis: 10/01 /2024 Policy Page: Underwriting Company: The Confinental Casualty Company 0 Copyright CNA All Rights Reserved.