Loading...
HomeMy WebLinkAboutALTA PLANNING + DESIGN, INC. (3) (� (�Jr /dry r A-2023-0 r J-0 A MAYOR i �A CITY MANAGER Valerie Amezcua f f•1AY 1 ZQ�6 ;! AlVaro Nunez MAYOR PRO TFM ,,d CITY ATTORNEY David Penaloza I - Sonia R.Carvalho COUNCILMEMBERS CITY CLERK Phil Bacerra , Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez - Thai Viet Phan Benjamin Vazquez CITY OF SANTA ANA c?'•Pwi�(E) Michaelarfi-L(gy) PUBLIC WORKS AGENCY 20 Civic Center Plaza I PO Box 1988 Santa Ana,California 92702 www.santa,-ana.0ra April 17, 2026 Alta Planning+Design, Inc. Attn: Steven Frieson, Vice President 711 SE Grand Avenue, Portland, OR 97214 Re: Extension of Agreement No.A-2023-075-02 to provide on-call engineering services, Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by Alta Planning + Design, Inc. and the City of Santa Ana, which commenced on May 2, 2023, the parties hereby exercise their option to extend the term of the Agreement for an additional one(1)year through May 1, 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, "�r11 R fo Rosas, E. Acting Executive Director, Public Works Agency CITY OF SANTA ATTEST � r - A varo Nunez ennife 1 City Manager City Clerk APPROVED AS TO FORM CONSULTANT � GSteven Frieson(Apr 23,2028 12:52:29 PDT) I e Nellesen By: Steven Frieson Assistant City Attorney Title: 1/ice President SANTA ANA CITY COUNCIL Valerie Amezcua David Penaloza Thai Viet Phan Benjamin Vazquez Jessie Lopez Phil Bacerra Johnathan Ryan Hernandez Mayor Mayor Pro Tam-Ward 6 ward 1 Ward 2 Ward 3 Ward 4 Ward 5 varriu=a dpenalazansanta-ana.mg tphangsanta-ana.prq bvazquezAsanta-ana.oro Iessielpoegi2sanla-anaArq pbacerraaSanla-ana_nm iryanhemandez(dsanta-ana.org Page 1 of 2 46.R CERTIFICATE OF LIABILITY INSURANCE DATE 01/0 lD2)(026rryyy) 0l/08/202s 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 WTW Certificate Center NAME: Willis Towers Watson Insurance Services West, Inc. PHONE 1-877-945-7378 FAX 1-888-967-2378 c/o 26 Century Blvd AIC Na: P.O. Box 305191 ADDRESS: A E SS: certificates@wtwco.Cam ADDRE Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC ft INSURER A1 National Union Fire Ins Co of Pittsburgh 19445 INSURED Allied World Insurance Company 22730 Alta Planning + Design, Inc. INSURERB; mp Y 101 SW Main St., Ste 2000 INSURER C;. AIU Insurance Company 19399 Portland, OR 97204 INSURERD: Allied World Surplus Lines Insurance Compa 24319 Berlin, NJ 06009 INSURER E; Lexington Insurance Company 19437 INSURER F; COVERAGES CERTIFICATE NUMBER:W43617133 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 RFOU)REMENT 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. ILTR TYPEOFrNSURANCE ADDLSUBR POLICYNUMBER MMI��YIYEYPYY MMIDDffYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ® OCCUR DAMAGE TO RENTED 2,000,000 PREMISES Ea occurrence $. A MED EXP(Any one person) $ 10,000 Y Y 042670158 12/31/2025 12/31/2026 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY❑JPERCOT ❑ LOC PRODUCTS $ 4,000,000 OTHER: 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident $ 5,000,000 Ea X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y 042670159 12/31/2025 12/31/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADF 0314-9729 12/31/2025 12/31/2026 AGGREGATE $ 5,000,000 DED I X RETENTIONS 10,000 $ WORKERS COMPENSATION X I PER STATUTE �RH AND EMPLOYERS'LIABILITY YIN C ANYPROPRIETORIPARTNERIEXECUTiVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUE No NIA Y 042670162 12/31/2025 12/31/2026 (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00C yes, IPTIbaunder D E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 1,000,000 D "Professional Liah incl Pollution Y 0313-8987 12/31/2025 12/31/2026 Each Claim Limit $5,000,000 Policy Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mare space is required) SEE ATTACHED Tu Tran° ig 19H.11ysoe by T.Tran Nguyen Nguyen oszr?o-Ceona APPROVED By Tu Tran Nguyen at 9:26 am,Jan 08,2026 1 CERTIFICATE HOLDER 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. CITY OF SANTA ANA 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE P.O. BOX 1988 - SANTA ANA, CA 92702 Y -- OO 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR in: 29220967 BATCH: 4270203 AGENCY CUSTOMER ID. LOC#: AC"RE) ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 16. � AGENCY NAMED INSURED Willis "rowers Watson Insurance Services West, Inc. Alta Planning + design, Inc. 101 SW Main St., Ste 2000 POLICY NUMBER Portland, OR 97204 See Page I Berlin, NJ 08009 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance RE: RFP 23-025 ON-CALL ENGINEERING SERVICES; ALT ON CALL NO. 00-ON23-013 AND ALL WORK ORDERS RELATING THERETO. The City, its officers, officials, employees and volunteers are included as Additional Insureds as respects to General Liability. General Liability policy shall be Primary and Non-Contributory with any other insurance in force for or which may be purchased by Additional Insureds. Waiver of Subrogation applies in favor of City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers with respects to General Liability, Auto Liability, Professional Liability and Workers Compensation as permitted by law. Alta Planning # Design, Inc is included as a Named Insured for Trilon Group, LLC. INSURER AFFORDING COVERAGE: National Union Fire Ins Co of Pittsburgh NAIC#: 19445 POLICY NUMBER: 042670160 EFF DATE. 12/31/2025 EXP DATE: 12/31/2026 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Auto Liability - MA Combine Single Limit $5,000,000 Any Auto Each Accident. INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399 POLICY NUMBER: 042670161 EFF DATE: 12/31/2025 EXP DATE: 12/31/2026 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation (WI) E.L. EACH ACCIDENT $1,000,000 & Employers Liability E.L. DISEASE - EA EMP $1,000,000 Per Statute E.L. DISEASE-POL LMT $1,000,000 INSURER AFFORDING COVERAGE: Lexington Insurance Company NAIC#: 19437 POLICY NUMBER: 012147867 EFF DATE: 12/31/2025 EXP DATE: 12/31/2026 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Liability Each Occurrence $5,000,000 excess of $5,000,000 ACORD 101 (2008/01) 02008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 29220967 BATCH: 4270203 CERT: W43617133 ENDORSEMENT This endorsement, effective 12:01 A.M. 12/31/2025 forms a part of Policy No. 042670159 issued to TRILON GROUP, LLC by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES SCHEDULE NAME OF PERSON OR ORGANIZATION E-MAIL OR U.S. POSTAL SERVICE ADDRESS PER SCHEDULE ON FILE WITH COMPANY 108538 (3/1 1) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate(s) holder(s) when this policy is canceled (hereinafter, the "Certificate Holders)") and has provided the Insurer, either directly or through it's broker of record, either: (a) the name of the entity shown on the certificate, a contact name at such entity and the U.S. Postal Service mailing address of each such entity; or (b) the email address of a contact at each such entity; and 3. prior to the effective date of cancellation, the First Named Insured confirms to the Insurer, either directly or through its broker of record, that the persons or organizations set forth in the Schedule above, as well as their respective addresses listed, should continue to be a part of the Schedule and, if not, the names of the persons or organizations that should be deleted, the Insurer will provide advice of cancellation (the "Advice") to each such Certificate Holder(s) confirmed by the First Named Insured in writing to be correctly a part of the Schedule within 90 days after the First Named Insured confirms the accuracy of the Schedule above with the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the First Named Insured confirms the accuracy of the Schedule above with the Insurer. Proof of the Insurer emailing the Advice, using the information provided and subsequently confirmed by the First Named Insured in writing, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1 . First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms, conditions and exclusions shall remain the same. Authorized Representative 108538 (3/1 1) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 POLICY NUMBER: 0426-70-159 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: TRILON GROUP, LLC Endorsement Effective Date: 12/31/2025 SCHEDULE Name(s) Of Persons} Or Organizations?: ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS REQUIRED TO PROVIDE A WAIVER. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 (g)Insurance Services Office, Inc., 2011 Page 1 of 1 ❑ ENDORSEMENT This endorsement, effective 12:01 A.M. 12/31/2025 forms a part of Policy No. 0426-70-158 issued to TRILON GROUP, LLC by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES SCHEDULE NAME OF PERSON OR ORGANIZATION E-MAIL OR U.S. POSTAL SERVICE ADDRESS PER SCHEDULE ON FILE WITH COMPANY 108538 (311 1) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate(s) holder(s) when this policy is canceled (hereinafter, the "Certificate Holders}"} and has provided the Insurer, either directly or through it's broker of record, either: (a) the name of the entity shown on the certificate, a contact name at such entity and the U.S. Postal Service mailing address of each such entity; or (b) the email address of a contact at each such entity; and 3. prior to the effective date of cancellation, the First Named Insured confirms to the Insurer, either directly or through its broker of record, that the persons or organizations set forth in the Schedule above, as well as their respective addresses listed, should continue to be a part of the Schedule and, if not, the names of the persons or organizations that should be deleted, the Insurer will provide advice of cancellation (the "Advice") to each such Certificate Holder(s) confirmed by the First Named Insured in writing to be correctly a part of the Schedule within 40 days after the First Named Insured confirms the accuracy of the Schedule above with the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the First Named Insured confirms the accuracy of the Schedule above with the Insurer. Proof of the Insurer emailing the Advice, using the information provided and subsequently confirmed by the First Named Insured in writing, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms, conditions and exclusions shall remain the same. 4� 4&4. Authorized Representative 108538 (311 1) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 POLICY NUMBER: 0426_70_158 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 WHOM YOU PER THE CONTRACT OR AGREEMENT BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Pagel of 2 ❑ A. Section II --- Who Is An Insured is amended to maintenance or repairs} to be performed by include as an additional insured the persons} or or on behalf of the additional insured(s) at organization(s) shown in the Schedule, but only the location of the covered operations has with respect to liability for "bodily injury", been completed; or "property damage" or "personal and advertising 2. That portion of "your work" out of which injury" caused, in whole or in part, by: the injury or damage arises has been put to 1. Your acts or omissions; or its intended use by any person or 2. The acts or omissions of those acting on Organization other than another contractor or your behalf; subcontractor engaged in performing in the performance of your ongoing operations operations for a principal as a part of the for the additional insured(s) at the location{s} same project. designated above. C. With respect to the insurance afforded to these additional insureds, the following is added to However: Section III - Limits Of Insurance: 1. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted required by a contract or agreement, the most by law; and we will pay on behalf of the additional insured 2. If coverage provided to the additional is the amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such additional insured will not be broader than 2. Available under the applicable limits of that which you are required by the contract insurance; or agreement to provide for such additional whichever is less. insured. This endorsement shall not increase the B. With respect to the insurance afforded to these applicable limits of insurance. additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, Page 2 of 2 0 Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: 0426-70-158 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 WHOM YOU PER THE CONTRACT OR AGREEMENT BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured the person{s) or B. With respect to the insurance afforded to organization(s) shown in the Schedule, but only these additional insureds, the following is with respect to liability for "bodily injury" or added to Section III — Limits Of Insurance: "property damage" caused, in whole or in part, If coverage provided to the additional insured is by "your work" at the location designated and required by a contract or agreement, the most described in the Schedule of this endorsement we will pay on behalf of the additional insured performed for that additional insured and is the amount of insurance: 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 whichever is less. by law; and This endorsement shall not increase the 2. if coverage provided to the additional applicable limits of insurance. 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. CG 20 37 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 0426-70-158 COMMERCIAL GENERAL LIABILITY CG24041219 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): PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO 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 Q Insurance Services Office, Inc., 2018 Page 1 of 1 ENDORSEMENT NO. 15 AMEND SUBROGATION CLAUSE;WAIVER OF SUBROGATION FOR CLIENTS AND THIRD PARTIES This Endorsement,effective at 12:01 a.m. on December 31,2025,forms part of Policy No. 0313-8987 Issued to Trilon Group,LLC Issued by Allied World Surplus Lines Insurance Company In consideration of the premium charged, it is hereby agreed that Section VIIL CONDITIONS, Subsection N. is deleted in its entirety and replaced as follows: N. SUBROGATION In the event of any payment under this Policy, the Company shall be subrogated to all the Insured's rights of recovery against any person or organization and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The Insured shall do nothing to prejudice such rights. The Company agrees to waive its right of subrogation against any client of the Insured or any other person or entity for a Claim which is covered by this Policy where the Insured agreed to waive any such rights in writing prior to the date the Wrongful Act giving rise to such Claim first occurred. Any recoveries shall be applied first to subrogation expenses, second to Damages and Defense Expenses paid by the Company, and third in satisfaction of the Policy Deductible shown in Item 4. of the Declarations. Any additional amounts recovered shall be paid to the First Named Insured. All other terms, conditions and limitations of this Policy shall remain unchanged. Authorized Representative AE 00062 (08/21) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. This endorsement, effective 12:01 AM 12/31/2025 forms a part of Policy No, 042670162 Issued to TRILON GROUP, LLC By A I U INSURANCE COMPANY 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. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED. 1 . PURSUANT TO THE WORKERS'COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY; OR 2. BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. This form is not applicable in Kansas for private construction contracts as defined in K.S.A. 16-1801 through K.S.A 16-1807 or public construction contracts as defined in K.S.A. 16-1901 through 16-1908, except where permitted by statute or other applicable law, such as for use in wrap-up insurance programs. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas, or Utah. WC 00 03 13 Y (Ed. 04184) Countersigned by _ _ _ Authorized Representative THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 12/31/2025 forms a part of Policy No. 0426-70-162 Issued to TRILON GROUP, LLC By AIU Insurance Company LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder(s) when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insured has provided the Insurer, either directly or through its broker of record, either: (a) the name of the entity shown on the certificate, a contact name at such entity and the U.S. Postal Service mailing address of each such entity; or (b) the email address of a contact at each such entity; and 3. prior to the effective date of cancellation, the Named Insured confirms to the Insurer, either directly or through its broker of record, that the persons or organizations set forth in the Schedule below, as well as their respective addresses listed, should continue to be a part of the Schedule and, if not, the names of the persons or organizations that should be deleted, the Insurer will provide advice of cancellation (the "Advice") to each such Certificate Holder(s) confirmed by the Named Insured in writing to be correctly a part of the Schedule withing0 days after the Named Insured confirms the accuracy of the Schedule below with the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured confirms the accuracy of the Schedule below with the Insurer. Proof of the Insurer emailing the Advice, using the information provided and subsequently confirmed by the Named Insured in writing, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: 1. Named Insured means the first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. WC 99 00 58 Page 1 of 2 (Ed. 04111) SCHEDULE NAME OF PERSON OR ORGANIZATION E-MAIL OR U.S. POSTAL SERVICE ADDRESS PER SCHEDULE ON FILE WITH COMPANY WC 99 00 58 Page 2 of 2 (Ed. 04111) ENDORSEMENT NO. 5 ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED LIMITED TO E-MAIL NOTIFICATION This Endorsement, effective at 12:01 a.m. on December 31,2025,forms part of Policy No. 0313-8987 Issued to Triton Group,LLC Issued by Allied World Surplus Lines Insurance Company In consideration of the premium charged,it is hereby agreed that: In the event that the Company cancels this Policy for any reason other than nonpayment of premium,and 1. the cancellation effective date is prior to this Policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate holder when this Policy is canceled (hereinafter, the "Certificate Holder(s)"); and has provided to the Company, either directly or through its broker of record,the email address of the contact at such entity; and 3. the Company receives this information after the First Named Insured receives notice of cancellation of this Policy and prior to this Policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Company; the Company will provide advice of cancellation (the "Advice") via e-mail to such Certificate Holders not later than thirty(30)days before the effective date of cancellation. Proof of the Company emailing the Advice, using the information provided by the First Named Insured,will serve as proof that the Company has fully satisfied its obligations under this Endorsement. This Endorsement does not affect, in any way, coverage provided under this Policy or the cancellation of this Policy or the effective date thereof, nor shall this Endorsement invest any rights in any entity not insured under this Policy. Any failure on the Insurer's part to deliver the Advice will not impose liability of any kind upon the Insurer or invalidate the cancellation. Any Certificate Holder is not an Insured or a Loss Payee under this Policy. No coverage will be available under this Policy for any Claim brought by or against any Certificate Holder. All other terms,conditions and limitations of this Policy shall remain unchanged. Authorized Representative AE 00025 00(03/21)