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HomeMy WebLinkAboutM. BREY ELECTRIC, INC. (2)MAYOR VEaisd o Arrozcua MAYD R PRO TEM Thai Viat Ptw COLWOLMENRF-As Phil Bacenra johna&= Ryan Harnandaz Jmiv Lopez 06VW per4oza 8enianin Vazquez INSURANCE ON FILE WORK MAY PROCEED LINTI IN4ANC EXPIRES CITY CL RK ` DATE MAR 0 6 2025 CITY OF SANTA ANA D .. p? P(1 Z) M. Brey Electric, Inc. DIAA 408ElmAve. (,per Beaumont, CA 92223 Attn: Matthew Brey, President IBC WORKS AGINff 20 Cvlc Canter Male • P.O. Box t988 Santa Aria, Caffwn}a 92702 :bra `L'T January 10, 2025 CITY MANAGER CtTY ATTMEY Sonia R. Carvalita CJTY CLM Jennifer L Ha Re: Extension of Agreement (A-2022-025-03) for On Call Electrical Repair and Rehabilitation Services Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by M. Brey Electric, Inc., and the City of Santa Ana; dated February 15, 2022 the time period of the Agreement is hereby extended for an additional two-year period, from February 15, 2025 through February 14, 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, Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA Al Alvaro Nunez City Manager APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney ATTEST M. BREY ELECTRIC, INC. I,,y el Nellesen Matthew Brey ssistant City Attorney President SAWA ANA CITY COUNCIL Vfh" Anma 119 TW Via Pteq Liz PIP4 Ryf Memer dei bwgi Pw oa fdeyxv Ffay Rurm. w"i WwdI Ward WAId4 WAM5 WAd9 . a.s.axad4!i .ems ay MBREYEL-01 NGARCIA '4414 o CERTIFICATE OF LIABILITY INSURANCE DAT/13/2D/YYYY) 2l13/2025 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 Orion Business Insurance and Risk Management Services, Inc. 1250 Corona Pointe Court, Suite 302 Corona, CA 92879 CONTACT Noemi Garcia NAME: PAHoNt o, Ext 626 773-8488 FAX ( ): ( ) (A1c, No):(951) 737-5083 AEbmAR1ES5, ngarcia@orionins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:CanO ius US Insurance Inc. 12961 INSURED INSURER B : National Fire & Marine Insurance Company 20079 INSURER C : Everest Premier Insurance Company 16045 M. Brey, Inc., dba MBE Construction P0Box 3159 Beaumont, CA 92223 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER- PPVtctntu tut 1A0=D. 1 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 I-TR TYPE OF INSURANCE ADDL D SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X X CUSP C19000173-00 11/13/2024 11/1312025 AMAGE DN PREMISE TOEaREoccurrTED nce $ 100,000 MED EXP (Any oneperson) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER : jECOT- GENERAL AGGREGATE $ 2,000,000 POLICY LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X OTHER: $5,000 BI1PD Ded per Occ B AUTOMOBILE LIABILITY EOMBINdEeDtSINGLE LIMIT 1,000,000 $ BODILY INJURY tPerperson) $ ANYAUTO X 72APBO10033 11113/2024 11/1312025 OWNED AUTOS ONLY X AUTOS BODILYINJURY Peraccident $ ROPERTY AMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE 5,000,000 EXCESS LIAB CLAIMS -MADE CUSXS20000077-00 11/1312024 11/13/2025 DED RETENTION $ C WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT 1,000,000 ANY PRO PRIEGDTIVE X 7600026637251 2/12/2025 2/12/2026 FFICERIMEMBEER1 EXCLUDED' ❑ Mandatory In NH) NIA E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under E.L. DISEASE • POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DIgiWyYgn Tu Tran b,r,, Nguyen N uyen D .:zgu.D= a APPROVED DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more sp By Tu Tran Nguyen at 3:01 pm, Feb 18, 2025 Project No: PO 7933 City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are listed as additional insureds as respects General Liability and Auto Liability with respect to liability arising out of work operations performed by or on behalf of Contractor including materials, parts, and equipment furnished in connection with such work or operations and automobiles owned, leased, hired, or borrowed by or on behalf of Contractor. Primary wording is included as respects General Liability per the attached policy form. Waiver of subrogation is included as respects General Liability and Workers' Compensation per the attached policy forms. Notice of cancellation will be delivered in accordance with the policy provisions. City of Santa Ana Attn: Public Works Agency, Water Resource Division 215 S. Center Street (M-85) Santa Ana, CA 92701 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 +i a AI;VKU LO (LU101U3) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CUSPC19000173-00 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) I Location(s) Of Covered Oneratiions All persons or organization where written contract with All locations at which you are performing operations the named insured requires additional insured status. for any person or organization with whom or with This form does not apply to your work on "New which you have agreed in writing in a contract or Residential Property", agreement that such person(s) or organization(s) shall be included 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 e Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2• 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section Ill — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance, will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 O Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: CUSPC19000173-00 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE. PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All Personals or organizations where written contract with the Named Insured requires additional insured completed operations coverage. This form does not apply to your work on "New Residential Property" All locations at which you are performing operations for any person or organization with whom or with which you have agreed in writing in a contract or agreement that such person(s) or organization(s) shall be included 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance. If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of insurance shown in the Declarations. CG 20 37 04 13 ©insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: CUSP C19000173-00 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 This insurance is primary to and will not seek additional insured. 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 CG 20 01 12 19 © Insurance Services Office, Inc„ 2018 Page 1 of 1 POLICY NUMBER: CUSPC19000173-00 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATEDSITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): All persons or organizations where required by written contract with the Named Insured signed by both parties prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 0412 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE —ADDITIONAL INSURED: City of Santa Ana Attn: Public Works Agency 215 S. Center Street (M-85) Santa Ana, CA 82701 A. In consideration of payment of the additional premium listed below, LIABILITY COVERAGE is extended to include the additional insured named herein, provided that: 1) such insurance applies only to the ownership, maintenance or use of a covered "auto"; and 2) such insurance applies only to acts or omissions by you, your agents or your "employees" while such covered auto is being used in your business; and 3) such insurance does not apply to the acts or omissions of the additional insured or any of the additional insured's agents or "employees" other than you; and 4) such insurance does not apply if the additional insured is subject to motor carrier insurance requirements and is not insured for hired "autos" under an "auto" liability insurance form that insures on a primary basis the owners of the "autos" and their agents and "employees" while the "autos" are being used exclusively in the additional insured's business and pursuant to operating rights granted to the additional insured by a public authority. B. The insurance afforded to such additional insured: 1) Applies only to the extent permitted by law; and 2) Will not be broader than that which you are required by a contract or agreement to provide for such additional insured. C. The most we will pay on behalf of the additional insured is the lesser of the amount of insurance: 1) That you are required by a contract or agreement to provide for such additional insured; or 2) That is available under the applicable Limits of Insurance shown in the Declarations, All other terms, conditions and agreements remain unchanged. Additional Premium M-6887 (0812017) Company Name Policy Number 72 APB 010033 National Fire & Marine Insurance Company Endorsement effective 11/1312024 Named Insured Countersigned by M BREY ELECTRIC INC (Authorized Representative) (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy .) M-6887 (08/2017) 110111012024 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE BLANKET WAIVER OF SUBROGATION REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHT FROM US PRIOR TO INJURY. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 02/12/2025 Policy No. 7600026637251 Endorsement No. 001 Insured: M. Brey Electric, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR PROFESSIONAL LIABILITY INSURANCE I, Matthew Brey, President ("Representative"), attest that I am an authorized (Name and Title of Vendor Representative) representative of MBE Construction p _ ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number R F P 21-122 ("Agreement") to provide On Call Electrical Repair and Rehabilitation Services (Services to be provided under aSreemenl/contmet) ("Services"): During the course and scope of Company's agreement with the City of Santa Ana, Company will not use the services of an expert necessitating professional liability/errors & omissions liability insurance coverage in the performance of Services to, for, or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum professional liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. r Signature Matthew Brey President Print Name "Title matt@rnbreyinc.com Contact Information, i.e., Telephone Number and/or Email Address 02/14/2025 Date Affidavit of Exemption for Professional Liability Insurance 11.12.2024 MBREYEL-01 NGARCIA ,d►coRo CERTIFICATE OF LIABILITY INSURANCE FD 1 1/17/20YYYY) /17/ 25 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 Noemi Garcia NAME: Orion Business Insurance and Risk Management Services,Inc. PHONE FAX 1250 Corona Pointe Court,Suite 302 (A/C,No,Ext):(626)773-8488 No):(951)737-5083 Corona,CA 92879 E-MAIL-ADDRESS:ngarcia@orionins.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:CanO ius US Insurance Inc. 12961 INSURED INSURERB:National Fire&Marine Insurance Company 20079 M.Brey,Inc.,dba MBE Construction INSURERC:Everest Premier Insurance Company 16045 P O Box 3159 INSURERD:Forte ra Specialty Insurance Company 16823 Beaumont,CA 92223 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CUSPC19000173-01 11/13/2025 11/13/2026 DAMAGE TO RENTED 100,000 X X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 71 PEA LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO X X 72APBO12913 11/13/2025 11/13/2026 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ccident $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE CUSXS20000077-01 11/13/2025 11/13/2026 AGGREGATE $ 5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER 7600026637251 2/12/2025 2/12/2026 1,000,000 ANY PROPRIETOR/ R/EXECUTIVE ❑ X E.L.EACH ACCIDENT $ EXCLU OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Errors&Omissions AXC1000402-01 10/9/2025 11/13/2026 [Each Claim 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Extension of Agreement(A-2022-025-03)for On Call Electrical Repair and Rehabilitation Services City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are listed as additional insured(s)as respects General Liability and Auto Liability per the attached policy forms.Primary wording is included as respects General Liability per the attached policy form.Waiver of subrogation is included as respects General Liability,Auto Liability,and Workers'Compensation per the attached policy forms.Notice of cancellation will be delivered in accordance with the policy provisions. Digitally signed by Tu Tran Tu Tran Nguyen ate:2025.1 Nguyen D61324-08'00'7 APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 4:12 pm,Nov 17, 2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Franklin Fallon 220 S.Daisy Ave Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CUSPC19000173-01 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) Locations Of Covered Operations All persons or organization where written contract with All locations at which you are performing operations the named insured requires additional insured status. for any person or organization with whom or with This form does not apply to your work on "New which you have agreed in writing in a contract or Residential Property". agreement that such person(s) or organization(s) shall be included 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 "bodilyinjury" or damage" or "personal and advertising injury" property damage occurring after: pp y caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III— Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: CUSPC19000173-01 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s) All Personals or organizations where written contract All locations at which you are performing operations for any with the Named Insured requires additional insured person or organization with whom or with which you have completed operations coverage. This form does not agreed in writing in a contract or agreement that such apply to your work on "New Residential Property" person(s)or organization(s)shall be included 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 in the "products-completed operations hazard". 1. Required by the contract or agreement;or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: CUSPC19000173-01 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 CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: CUSPC19000173-01 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 DESIGNATEDSITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): All persons or organizations where required by written contract with the Named Insured signed by both parties prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 M-5887(08/2017) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE—ADDITIONAL INSURED: City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers 220 S.Daisy Ave. Santa Ana,CA 92701 A. In consideration of payment of the additional premium listed below, LIABILITY COVERAGE is extended to include the additional insured named herein, provided that: 1) such insurance applies only to the ownership, maintenance or use of a covered"auto"; and 2) such insurance applies only to acts or omissions by you,your agents or your"employees"while such covered auto is being used in your business; and 3) such insurance does not apply to the acts or omissions of the additional insured or any of the additional insured's agents or"employees" other than you; and 4) such insurance does not apply if the additional insured is subject to motor carrier insurance requirements and is not insured for hired"autos" under an"auto"liability insurance form that insures on a primary basis the owners of the"autos" and their agents and"employees"while the"autos" are being used exclusively in the additional insured's business and pursuant to operating rights granted to the additional insured by a public authority. B. The insurance afforded to such additional insured: 1) Applies only to the extent permitted by law; and 2) Will not be broader than that which you are required by a contract or agreement to provide for such additional insured. C. The most we will pay on behalf of the additional insured is the lesser of the amount of insurance: 1) That you are required by a contract or agreement to provide for such additional insured; or 2) That is available under the applicable Limits of Insurance shown in the Declarations. All other terms, conditions and agreements remain unchanged. Additional Premium: $ 0 Company Name Policy Number 72 APB 012913 National Fire&Marine Insurance Company Endorsement Effective 11/17/2025 12:01 AM Named Insured Countersigned by M. BREY INC (Authorized Representative) (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) M-5887(08/2017) 11/21/2024 POLICY NUMBER: 72 APB 012913 M-5144a(06/2007) WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 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 modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 11/17/2025 12:01 AM Named Insured: M. BREY INC (Authorized Representative) SCHEDULE Name Of Person(s)Or Organization(s): City of Santa Ana, its City Council,officers,officials,employees, agents,and volunteers 220 S. Daisy Ave. Santa Ana, CA 92701 Additional Premium $ (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s)or organiza- tion(s)shown in the Schedule. We will retain the additional premium shown above, regardless of any early termi- nation of this endorsement or the policy. Includes copyrighted material of Insurance Services Office,Inc.with its permission. M-5144a(06/2007) 11/21/2024 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2%of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE BLANKET WAIVER OF SUBROGATION REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHT FROM US PRIOR TO INJURY. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 02/12/2025 Policy No. 7600026637251 Endorsement No. 001 Insured: M.Brey Electric,Inc. Premium$INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual-1999.