HomeMy WebLinkAboutDUDEK, INC.City of Santa Ana
i Clerk of the Cou1- d
AGREEMENT TERMINATION FORM
Please complete this form in its entirety when the attached agreement and all
amendments (if any) are no longer in effect.
Note: If your agreement is grant related, please ensure that all grant retention requirements
have been satisfied prior to signing the termination form.
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Return form to the Clerk of the Council Office (M-30).
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The agreement with h ojk`
City of Santa Ana
A a 02 2021
Clerk of the Council
N-2019-089
No. was completed on \0 1 and final payment has been made.
(List all amendments. Use space below if needed.) ,
Department: ?a r.Si�-/ �vn,A
Phone/Ext.:
Signature: U/ a�
Date:
Revised: 10-18-16
iNSURAtdvE ON FILE N-2019-089
WORK MAY PROCEED
RA GE EXPIRES
CLEi1Clt� —
6 6, MA�002019
AGREEMENT WITH DUDEK INC. TO PROVIDE TEMPORARY
iL JLs4'"Z+/tt y REPAIRS SERVICES AT THORNTON LAKE
THIS AGREEMENT is made and entered into on this 2l st day of December, 2018 by and between
Dudek, Inc., a California corporation, ("Consultant"), and the City of Santa Ana, a charter city and
municipal corporation organized and existing under the Constitution and laws of the State of
California ("City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
providing consultation consisting of developing design detail drawings and specifications
for a contractor to construct a temporary repair in the southerly portion of the lake edge at
Thornton Park.
B. Consultant and the City entered into a prior Agreement (#N-2018-106) on April 30, 2018,
The Agreement expired on October 31, 201 S. The parties consulted and determined that
the services provided by the Consultant were not completed and required additional time
to complete. The parties agree to the use of the prior scope of services provided in
Agreement #N-2018-106 and the terms for compensation to complete said services.
C. Consultant represents that Consultant is able and willing to provide and complete such
services to the City.
D. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall perform during the term of this Agreement, the tasks and obligations
regarding this consultation, including all labor, materials, tools, equipment, and incidental
customary work required to fully and adequately complete the services described and set forth in
Exhibit A, attached hereto and incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for
City, the rates and charges identified in Exhibit A. The total amount to be expended
under the term of this agreement shall not exceed $5,000 which includes $3,600
provided in the attached exhibit and a contingency amount of $1,400 for additional
services provided at the sole discretion of the City.
Page I of 8
b, City agrees to compensate Consultant for any services rendered following the
expiration of Agreement #N-2018-106 until the commencement date of this Agreement
mentioned in Section 3, below.
c. Payment by City shall be made within 45 days (forty-five) days following receipt of
proper invoice evidencing work performed, subject to City accounting procedures.
Payment need not be made for work which fails to meet the standards of performance
set forth in the Recitals which may reasonably be expected by City.
3. TERM
This Agreement shall commence on December 21, 2018 and expire on October 31, 2019,
unless terminated earlier in accordance with Section 15, below.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor shall
it be construed to create an employer -employee relationship, a joint venture relationship, or to
allow the City to exercise discretion or control over the professional manner in which Consultant
performs the services which are the subject matter of this Agreement; however, the services to be
provided by Consultant shall be provided in a manner consistent with all applicable standards and
regulations governing such services. Consultant shall pay all salaries and wages, employer's social
security taxes, unemployment insurance and similar taxes relating to employees and shall be
responsible for all applicable withholding taxes.
5. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or
caused to be prepared by Consultant under this Agreement ("Documents & Data'). Consultant
shall require all subcontractors to agree in writing that City is granted a non-exclusive and
perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Consultant represents and warrants that Consultant has the legal right to license any and all
Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data which were provided to Consultant by the City. City shall not be limited in
any way in its use of the Documents and Data at any time, provided that any such use not within
the purposes intended by this Agreement shall be at City's sole risk.
6. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall maintain
and shall require its subcontractors, if any, to obtain and maintain insurance as described below:
Page 2 of 8
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, employees, agents,
volunteers and representatives as additional insured(s) and shall include, but not be
limited to protection against claims arising from bodily and personal injury,
including death resulting therefrom and damage to property, resulting from any act
or occurrence arising out of Consultant's operations in the performance of this
Agreement, including, without limitation, acts involving vehicles. The amounts of
insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property
damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the
aggregate. Such insurance shall (a) name the City, its officers, employees, agents,
and representatives as additional insured(s); (b) be primary and not contributory
with respect to insurance or self-insurance programs maintained by the City; and
(c) contain standard separation of insureds provisions.
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include
coverage for owned, hired and non -owned automobiles.
C. Worker's Compensation Insurance. In accordance with the provisions of Section
3700 of the Labor Code, Consultant, if Consultant has any employees, is required
to be insured against liability for worker's compensation or to undertake self-
insurance. Prior to commencing the performance of the work under this
Agreement, Consultant agrees to obtain and maintain any employer's liability
insurance with limits not less than $1,000,000 per accident.
d. If Consultant is or employs a licensed professional such as an architect or engineer:
Professional liability (errors and omissions) insurance, with a combined single limit
of not less than $1,000,000 per claim with $2,000,000 in the aggregate.
e. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
i. Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
ii. Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved by the City.
iii. Certificates and policies shall state that the policies shall not be canceled or
reduced in coverage or changed in any other material aspect without thirty
(30) days prior written notice to the City.
iv. Where the amounts or coverage provided by the certificates of insurance
provides coverage greater than those listed by this Agreement, the amounts
provided by the certificates of insurance shall be incorporated by reference
into the Agreement.
V. Consultant shall supply City with a fully executed additional insured
endorsement.
f. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has
been procured and is in force and paid for, the City shall have the right, at the City's
Page 3 of 8
election, to forthwith terminate this Agreement. Such termination shall not affect
Consultant's right to be paid for its time and materials expended prior to notification
of termination. Consultant waives the right to receive compensation and agrees to
indemnify the City for any work performed prior to approval of insurance by the
City.
7. INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents, employees, contractors, special counsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for
personal injury, including death, and claims for property damage, which may arise from the
negligent operations of the Consultant, its subcontractors, agents, employees, or other persons
acting on its behalf which relates to the services described in section 1 of this Agreement; and (2)
from any claim that personal injury, damages, just compensation, restitution, judicial or equitable
relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and
hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial
or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in
this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant
further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including
fees and costs for special counsel to be selected by the City, regarding any action by a third party
challenging the validity of this Agreement, or asserting that personal injury, damages, just
compensation, restitution, judicial or equitable relief due to personal or property rights arises by
reason of the terms of, or effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing,
to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity
shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of,
pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant.
8. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and
employees against any and all liability, including costs, for infringement of any United States'
letters patent, trademark, or copyright infringement, including costs, contained in the work product
or documents provided by Consultant to the City pursuant to this Agreement.
9. RECORDS
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all
Page 4 of 8
work, data, documents, proceedings, and activities related to this Agreement for a period of three
(3) years from the date of final payment to Consultant under this Agreement.
10. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees that
it shall not use or disclose such information except in the performance of this Agreement, and
further agrees to exercise the same degree of care it uses to protect its own information of like
importance, but in no event less than reasonable care. "Confidential Information" shall include all
nonpublic information. Confidential information includes not only written information, but also
information transferred orally, visually, electronically, or by other means. Confidential
information disclosed to either party by any subsidiary and/or agent of the other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any
information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the
Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant
without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e)
is independently developed by the Consultant without reference to information disclosed by the
City.
11. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under this
Agreement.
12. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status,
sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by
applicable law, in the recruitment, selection, training, utilization, promotion, termination or other
employment related activities. Consultant affirms that it is an equal opportunity employer and shall
comply with all applicable federal, state and local laws and regulations.
13. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the terms
of this Agreement shall prevail. This Agreement may not be modified except by written instrument
signed by the City and by an authorized representative of Consultant. The parties agree that any
terms or conditions of any purchase order or other instrument that are inconsistent with, or in
addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each
party to this Agreement acknowledges that no representations, inducements, promises or
agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any
party, which is not embodied herein.
Page 5 of 8
14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement shall
be construed to limit the City's ability to have any of the services which are the subject to this
Agreement performed by City personnel or by other consultants retained by City.
15. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of
termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to
deliver to the City all work product(s) completed as of such date, and in such case
such work product shall be the property of the City unless prohibited by law, and
Consultant consents to the City's use thereof for such purposes as the City deems
appropriate.
b. Payment need not be made for work which fails to meet the standard of
performance specified in the Recitals of this Agreement.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or
remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not
similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
17. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by the laws of the State of California. Both parties further agree that
Orange County, California, shall be the venue for any action or proceeding that may be brought or
arise out of, in connection with or by reason of this Agreement.
18. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder
and required by the laws and regulations of the United States, the State of California, the City of
Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and
Page 6 of 8
in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and
exemptions. Said inability shall be cause for termination of this Agreement.
19. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms of
this Agreement, and shall indemnify City fully, including reasonable costs and
attorney's fees, for any injuries or damages to City in the event that such authority
or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
20. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement
shall be in writing and shall be deemed to be properly given if delivered in person or mailed by
first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in
the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
With courtesy copies to:
Executive Director,
Parks, Recreation and Community
Services Agency
City of Santa Ana
20 Civic Center Plaza (M-23)
P.O. Box 1988
Santa Ana, California 92702
Fax: (714) 571-4211
To Consultant:
Dudek, Inc.
27372 Calle Arroyo
San Juan Capistrano, CA 92675
Fax: (949) 450-2626
Page 7 of 8
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by fax, communication shall be effective or deemed to have
been given twenty-four (24) hours after the time set forth on the transmission report issued by the
transmitting facsimile machine, addressed as set forth above. For purposes of calculating these
time frames, weekends, federal, state, County or City holidays shall be excluded.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST -
I - 0��
Norma Mitre
Acting Cleric of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By: AOlA°tGL A. �wC v' w
LAURA A. ROSSINI
Senior Assistant City Attorney
RECOMMENDED FOR APPROVAL:
[S UDLOFF
ecutive Director
Park, Recreation and Community Services Agency
CITY OF SANTA ANA
KRISTINE RIQ'fE
City Manager
CONSULTANT:
T Frank Dudek
Chairman I s
Page 8 of 8
EXHIBIT A
SCOPE OF SERVICES and COMPENSATION
Exhibit A
April 2, 2018
Mr. Mike Lopez
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92701
Subject: Proposal for Thornton Park Lake Temporary Repair Consulting Services
Dear Mr. Lopez:
Thank you for giving us the opportunity to submit our proposal to assist the City of Santa Ana in the
necessary temporary repairs for the Thornton Park Lake. The Dudek team is poised to assist the City
will all of their lake consultation needs.
Project Understanding and Approach
We understand the City has drained down the Thornton Park Lake in an effort to identify and repair a
leak in the lake wall. During the drain -down it was determined that the lake liner system is in poor
condition and is in need of rehabilitation. It is thought that the saturated soils along the lake edge in
the vicinity of the southerly portion of the lake could be due in part to leakage through the lake bottom
liner as well as through the lake edge wall. Dudek observed the area of the leak and condition of
exposed portion of the lake wall and bottom liner on March 27, 2018. Due to the very poor condition
of the PVC lake bottom liner, we recommended that the City implement a temporary repair to the lake
wall and a portion of the lake bottom to mitigate the saturated soils condition and address the overall
lake liner condition in a separate lake rehabilitation project. In our opinion, the existing liner system
has performed beyond its service life and has expired, and is in need of complete rehabilitation.
Scope of Services
Dudek will provide general lake repair consultation consisting of developing design detail drawings
and specifications for a contractor to construct a temporary repair in the southerly portion of the lake
edge. Dudek will attend project meetings, site meetings, and participate in conference calls as
requested by the City to provide guidance and consultation on the repair.
Fee
Dudek proposes a Time and Materials (T&M) fee not to exceed $3,600.00. This fee allows for a
maximum of 17 man-hours to provide the services described above to the City.
We appreciate the opportunity to submit this proposal and we look forward to assisting the City with
this project. If you have any question or wish to discuss our proposal please contact me at
949.212.0916 or jsmith@dudek.com with any questions about our proposal. Thank you.
Sincerely,
J
(MMIDDITTYI
AFRO CERTIFICATE OF LIABILITY INSURANCE DnT5/3/2019 )
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 endomement(s).
PRODUCER CONTACT
Hall & Company PHONE Allison Barga Licesnse#OK93926 FAX _-
A/E Insurance Services AA/CNo.Ext): 360-626-2007 to)c Not: 360-626-2007
19660 10th Ave NE E-MAIL ---
ADDRESS;barga@hallan adcornpanycom._
PoulsboWA98370 INSURER(S)AFFORDINGCOVERAGE NAIC4
INSURER A: Zurich American Insurance Company 16535
INSURED 25
Dudek INSURERS Steadfast Insurance Company 26387
605 3rd Street I INSURE RC
Encinitas CA 92024 INSURERD
CO\/FRAr;FS nFeTIDIr.ATF NI IIIIIRFD• 1 l acn n co00 ocnclr�u
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,
INTRR
TYPE OF INSURANCE
ADD(SU9R
POLICY NUMBER
POLICY SEE
MMIDDIYYYY
POLICY EXP
MM/ODIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
_ _ /BFPD _
GLOO14631102
8/28/2018
8/28/2019 EACH OCCURRENCE $1,000,000
I DAMAGE TO RE TED
1 PREMISES( a. occurrence) $ 100,000
X
X
....
1
Cross LiabilityPERSONAL
& ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY �X] JECT LOG
GENERAL AGGREGATE $2,000,000
PRODUCTS-COMP/OPAGG $2,000,000
OTHER'.
$
A
AUTOMOBILE
LIABILITY
BAP014632902
8/28/2018
8/28/2019
'I COMBINED tSINGLE LIMIT
$1,000,000
ANY AUTO
BODILY INJURY (Per person)
$
OWNED r SCHEDULED
AUTOS ONLY 'AUTOS
BODILY INJURY Per accident
( )
$
PX
HIRED Xy NON -OWNED
AUTOS ONLY AUTOS ONLY
I
1,
PROPERTY DAMAGE
Per accident
$
$
A '', X I UMBRELLALIAB X I OCCUR
AUC014640702 8/28/2018
8/28/2019
EACH OCCURRENCE
$1,000,000
AGGREGATE
_
$ 1,000,000
I$
EXCESS LIAB '_ CLAIMS -MADE
I,
DED X RETENTION$ I,
_ _
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? NIA
WC014633002
8/28/2018 ''. 8/2812019
X PER OTH-
—_ STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L.DISEASE - EA EMPLOYEE'',
-
S1,000,000
(Mandatory (Mandatory In NH)
f yes, describe under
E.L. DISEASE -POLICY LIMIT
-
"' S 1,000,000
DESCRIPTION OF OPERATIONS be
e
Professional Had Claims Made
Contractors Pollution Job: Occur
1
PECO14831402
8/28/2018
8/28/2019 $1,000,000 Per Claim
$2,000,000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Re: Thornton Lake Repairs - N-2018-106
The City, its officers, employees, agents, and representatives are an Additional Insured on the Commercial General Liability an Auto Liability w n required by
written contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability in cc is prima surance and
any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A 11�,,i er of subrog n applies to the
Commercial General Liability, Auto Liability, Umbrella / Excess Liability and Workers Compensation /Employers Liabili.11, Wor of the A Itional Insured.
�T✓S /�yV
CFRTIFICATF Hni OOP nAKlrRl I ATlnkl v r �a..M.n
SHOULD ANY OF THE ABOVE DES
SEY[SIES BE CANCELLED BEFORE
THE EXPIRATION DATE THE
OF,-fJ.-Qf, �. WILL BE DELIVERED IN
City of Santa Ana
20 Civic Center Plaza (M-30)
ACCORDANCE WITH THE POD PROVI44`IbYJS.
AUTHORIZED�TORIRII,Z�,ED REPRESENTATIVE
(' / .Z, 7
P.O. Box 1988
Santa Ana CA 92702-1988
l9J louts-ZU1D ACUKU CORPURATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Waiver Of Subrogation (Blanket) Endorsement
Policy No.
Eff. Date of Pot.
I E.P. Date of Pot.
I Eff. Date of End.
Producer
Add'l. Prom
Return Preen,
GL0014631102
1 08/28/2018
1 08/28/2019
08/28/2018
N/A
$ N/A
N/A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
The following is added to the Transfer 01' Rights Of Recovery Against Others To Us Condition:
If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from
others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to
any other operations in which the insured has no contractual interest.
e.01
4?�
II-OL-925-H CW (12/01)
Page 1 of t
Coverage Extension Endorsement
Policy No.
I Eff. Date of Pol.
I Exp. Date of Pol.
I Eff. Date of End.
I Producer No.
I Add'I. Prem
Return Prem.
BAP014632902
08/28/2018
1 08/28/2019 1
08/28/2018
1N/A
I N/A
N/A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who is An Insured Provision in Section 11 —Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts
performed within the scope of employment by you. Any "employee" of yours is also an "insured" while
operating an "auto" hired or rented under a contract or agreement in an "employee`s" name, with your
permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or
borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and /i1.b. in this endorsement
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract
or written agreement with you executed prior to any "accident", including those person(s) or organization(s)
directing your work pursuant to such written contract or written agreement with you, provided the "accident"
arises out of operations governed by such contract or agreement and only up to the limits required in the
written contract or written agreement, or the Limits of Insurance shown In the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you
executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained
by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond
the terms and conditions of the Coverage Form.
B. Amendment — Supplementary Payments
Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II — Cove Autos
Coverage are replaced by the following:
Pi (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violatiQrequfr \ b
"accident" we cover. We do not have to furnish these bonds. e) P . A ,
(4) All reasonable expenses incurred by the 'insured" at our request, including actual loss of' L
day because of time off from work.\ 0
of an
IJ-CA-424-F CW (04114)
Page 1 of 6
Includes copyrighted material of Insurance services Office, Inc., with its permission.
C. Fellow Employee Coverage
The Fellow Employee Exclusion contained in Section 11— Covered Autos Liability Coverage does not apply.
D. Driver Safety Program Liability and Physical Damage Coverage
1. The following is added to the Racing Exclusion in Section 11 —Covered Autos Liability Coverage:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the
Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage
Coverage of the Motor Carrier Coverage Form:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
E. Lease or Loan Gap Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Lease Or Loan Gap Coverage
In the event of a total 'loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered
"auto", less:
a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and
b. Any:
(1) Overdue lease or loan payments at the time of the 'loss";
(2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
(3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the
loan or lease; and
(5) Carry-over balances from previous leases or loans.
F. Towing and Labor
Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following:
We will pay up to $75 for Dewing and labor costs incurred each time a covered "auto" of the private passenger type is
disabled. However, the labor must be performed at the place of disablement.
G. Extended Glass Coverage
The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section:
If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and
is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass
repaired rather than replaced.
H. Hired Auto Physical Damage —Increased Loss of Use Expenses
The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Sectis replaced b the
following:
Loss Of Use Expenses
For Hired Auto Physical Damage, we will pay expenses for which an "insured" becoe legally91Ta spay for
loss of use of a vehicle rented or hired without a driver under a written rental contract or writtenag% ent. We
will pay for loss of use expenses if caused by: i\16 \�
LLCA-424•F CW (04114)
Page 2 of 6
Includes copyrighted material of Insurance Services office, Inc., with its permission.
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered
"auto";
(2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided
for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto".
However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000,
I. Personal Effects Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Personal Effects Coverage
a. We will pay up to $750 for "loss" to personal effects which are:
(1) Personal property owned by an "insured"; and
(2) In or on a covered "auto".
b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of:
(1) The reasonable cost to replace; or
(2) The actual cash value.
c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered
"auto No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of
the following:
(1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other
documents of value.
(2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches,
precious or semi-precious stones.
(3) Paintings, statuary and other works of art.
(4) Contraband or property in the course of illegal transportation or trade.
(5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment.
Any coverage provided by this Provision is excess over any other insurance coverage available for the same 'loss".
J. Tapes, Records and Discs Coverage
1. The Exclusion in Paragraph B.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage
Form and the Exclusion in Paragraph B.2.c. of Section IV — Physical Damage Coverage In the Motor Carrier
Coverage Form does not apply.
2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the
Physical Damage Coverage Section:
We will pay for 'loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic
equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices:
(a) Are the property of an "insured"; and
(b) Are in a covered "auto" at the time of "loss". ;�
The most we will pay for such 'loss" to tapes, records, discs or other similar devices�s�$500. The
Damage Coverage Deductible Provision does not apply to such "loss". 1ej �A
.1.
e
U-CA-424-F Cw (04/14)
Page 3 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
K. Airbag Coverage
The Exclusion in Paragraph B.3.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form
and the Exclusion in Paragraph B.4.a. of Section lY — Physical Damage Coverage in the Motor Carrier Coverage
Form does not apply to the accidental discharge of an airbag.
L. Two or More Deductibles
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you
by us, the following applies for each covered "auto" on a per vehicle basis:
1. If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or
2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by
the amount of the smaller (or smallest) deductible.
M. Physical Damage — Comprehensive Coverage — Deductible
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to
Comprehensive Coverage for all "loss" from any one cause is $5,000 or the deductible shown in the Declarations,
whichever is greater.
N. Temporary Substitute Autos — Physical Damage
1. The following is added to Section 1 —Covered Autos:
Temporary Substitute Autos — Physical Damage
If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following
types of vehicles are also covered "autos" for Physical Damage Coverage:
Any"auto" you do not own when used with the permission of its owner as a temporary substitute for a covered
"auto" you do own but is out of service because of its:
1. Breakdown;
2. Repair,
3. Servicing;
4. "Loss"; or
5. Destruction.
2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section;
Temporary Substitute Autos — Physical Damage
We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or
omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other
party.
The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it
replaces.
O. Amended Duties in The Event Of Accident, Claim, Suit Or Loss
Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is
a. In the event of "accident", claim, "suit' or "loss", you must give us or our authorized;
of the "accident", claim, "suit" or "loss". However, these duties only apply whei?*
"loss" is known to you (if you are an individual), a partner (if you are a partnership), a
liability company) or an executive officer or insurance manager (if you are a core
XI
notice
suit" or
limited
of any
11CA-424-F CW (04114)
Page 4 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate
the insurance afforded by this policy.
Include, as soon as practicable:
(1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written
notice of the claim or "suit" Including, but not limited to, the date and details of such claim or "suit,
(2) The "Insured's" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your
failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon
as practicable after the fact of the delay becomes known to you.
P. Waiver of Transfer Of Rights Of Recovery Against Others To Us
The following Is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only
applies to the person or organization designated in the contract.
Q. Employee Hired Autos — Physical Damage
Paragraph h. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other
Insurance Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced
by the following:
For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own:
(1) Any covered "auto" you lease, hire, rent or borrow; and
(2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or
elected or appointed official with your permission while being operated within the course and scope of that
"employee's" employment by you or that elected or appointed official's duties as respect their obligations to you.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
R Unintentional Failure to Disclose Hazards
The following is added to the Concealment, Misrepresentation Or Fraud Condition:
However, we will not deny coverage under this Coverage Form if you unintentionally:
(1) Fail to disclose any hazards existing at the Inception date of this Coverage Form; or
(2) Make an error, omission, improper description of "autos" or other misstatement of information.
You must notify us as soon as possible after the discovery of any hazards or any other information that was not
provided to us prior to the acceptance of this policy.
S. Hired Auto —World Wide Coverage
Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following:
(5) Anywhere in the world If a covered "auto" Is leased, hired, rented or borrowed for a period of 60 days or less,
T. Bodily Injury Redefined
The definition of "bodily injury" in the Definitions Section is replaced by the following:�� C /1�`
"Bodily injury" means bodily injury, sickness or disease, sustained by a person includingath or me71' an
resulting from any of these at any time. Mental anguish means any type of mental or e�tAju final illness "as
lI-CA-424-F CW (04114)
Page 5 of 6
Includes copyrighted material of Insurance services ONice, Inc, with Its permission.
U. Expected Or Intended Injury
The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II — Covered Auto Liability
Coverage is replaced by the following:
Expected Or Intended Injury
"Bodily Injury" or "property damage" expected or Intended from the standpoint of the "insured". This exclusion does
not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or
property.
V. Physical Damage —Additional Temporary Transportation Expense Coverage
Paragraph A.4.a. of Section III — Physical Damage Coverage is replaced by the following:
4. Coverage Extensions
a. Transportation Expenses
We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you
because of the total theft of a covered "auto" of the private passenger type. We will pay only for those
covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will
pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and
ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its
"loss".
W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto
The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section:
In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or
"auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost
of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a
maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto' powered by an alternative
fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease
agreement.
To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of
propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas,
either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be
powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by
biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source.
X. Return of Stolen Automobile
The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section:
If a covered "auto" is stolen and recovered, we will pay the cost of transport to return the "auto" to you. We will pay
only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage.
Al other terms, conditions, provisions and exclusions of this policy remain the same.
U-CA-424-F CW (04/14)
Page 6 of 6
Includes copyrighted material of Insurance Services Office, Inc., with Its permission
Additional Insured —Automatic — Owners, Lessees Or
Contractors
Policy No.
I Eff. Date of Pol.
Exp. Date of Pol.
Eff. Date of End.
Producer No.
Add']. Prem
Return Prom.
GLOO14631102
1 08/28/2018
08/28/2019
08/28/2018
64955000
------
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured:
Address (including ZIP Code):
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured on this policy under a written contract or written agreement. Such person
or organization is an additional insured 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
2. The acts or omissions of those acting on your behalf,
in the performance of your ongoing operations or "your work' as included in the "products -completed operations
hazard", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for
such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to
render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the
"bodily injury" or "property damage", or the offense which caused the "personal and advertising i ry", involved the
rendering of or the failure to render any professional architectural, engineering or surveying sere
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
� gyp.
-GL-1175-F CW (04/13)
Page 1 of 2
C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV —
Commercial General Liability Conditions:
The additional insured must see to It that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement
requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV— Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy
in which the additional insured is a Named Insured on such other policy and where our policy is required by a
written contract or written agreement to provide coverage to the additional insured on a primary and non-
contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional Insureds, and which endorsement applies specifically to
that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to
Section III — Limits Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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.
All other terms and conditions of this policy remain unchanged.
U-GL-1175-F CW (04/13)
Page 2of2
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy Number: WC014633002
VVORKEMYCOMPENSATION AND EMPLOYERV LIABfLn,y wsuRANa PoLicy WC 04 03 06
MTME&
We have the right %) recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization earned in the $Osdufo, (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 mirst maint'Win payroll records accurately segreg
the, work described in the Schedule. , , abr}g the remuneration of your employees while engaged in
The additional premium for this endorsement shall he 0 '/P of the California workers' compensation pre.
rniurn otherwise due oil such remuneration.
ZEMEM��
IM
WC 2U (4-84�
WC 04 W of, (Ed, 4 en Page T 0 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY U-WC-100-A CW (10116)
NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT
This endorsement is used to add the following to Part Six of the policy,
PART SIX — CONDITIONS
F. Notification To Others Of Cancellation
1. If we cancel this policy by written notice to you for any reason other than nonpayment of premium, we will
deliver electronic notification to each person or organization shown in a Schedule provided to us by you.
Such Schedule:
a. Must be initially provided to us within 15 days:
After the beginning of the policy period shown In the Declarations; or
After this endorsement has been added to policy;
b. Must contain the names and e-mail addresses of only the persons or organizations requiring
notification that this policy has been cancelled;
c. Must be in an electronic format that is acceptable to us; and
d. Must be accurate.
Such Schedule may be updated and provided to us by you during the policy period. Such updated
Schedule must comply with Paragraphs b. c. and d. above.
2. Our delivery of the electronic notification as described in Paragraph 1. of this endorsement will be based
on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered
to you. Delivery of the notification as described in Paragraph 1. of this endorsement will be completed as
soon as practicable after the effective date of cancellation to you.
3. Proof of e-mailing the electronic notification will be sufficient proof that we have complied with Paragraphs
1. and 2. of this endorsement.
4. Our delivery of electronic notification described in Paragraphs 1, and 2. of this endorsement is intended
as a courtesy only. Our failure to provide such delivery of electronic notification will not:
a. Extend the policy cancellation date;
b. Negate the cancellation; or
c. Provide any additional insurance that would not have been provided in the absence of this
endorsement.
5. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the
Schedule provided to us as described in Paragraphs 1. and 2. of this endorsement.
All other terms and conditions of this policy remain unchanged.
This endorsement changes the policy to which it is attached and is effective on the date issued unless of e stated.
(The information below is required only when this endorsement Is issued subsequent to preparatlt�1` he p Icy.
Endorsement Effective Policy No. Endors l i No. u
Insured mium'"
Insurance Company
C.
Q
U-WC-100-A CW (10/16)
Includes copyrighted material of National Council on Compensation Insurance, Inc. used with its permission.
Blanket Notification to Others of Cancellation
ZURICH
Policy No. Eff Date of Pol. Exp.Date of Pol. Eff Date of End. Producer Add'I Prem. Return Prem.
PEC 0146314-02 08/28I2018 08/28/2019 08/28/2018 64955000 __________ __________
Named Insured and Mailing Address: Producer.
DUDEK MICHAEL J. HALL & COMPANY
605 3RD ST 19660 10TH AVE NE
ENCINITAS, CA 92024-3513 POULSBO, WA 96370-7554
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Agribusiness Pollution Liability Insurance Policy - Claims Made and Reported Coverage
Commercial Umbrella Liability Policy
Commercial Umbrella Liability Policy — Claims Made and Reported Coverage
Contractor's Pollution Liability Insurance Policy
Contractor's Pollution Liability Insurance Policy - Claims Made and Reported Coverage
Environmental Cleanup and Liability Insurance Policy - Claims Made and Reported Coverage
Environmental Impairment Liability Insurance Policy - Claims Made and Reported Coverage
Environmental Services Package Policy
Excess Environmental Insurance Policy - Claims Made and Reported Coverage
Follow Form Excess Liability Policy
Follow Form Excess Liability Policy — Claims Made and Reported Coverage
Healthcare Pollution Liability Insurance Policy - Claims Made and Reported Coverage
Lender Environmental Collateral Protection and Liability Insurance Outstanding Loan Balance - Claims Made and
Reported Coverage
Lender Environmental Collateral Protection and Liability Insurance Policy — Claims Made and Reported Coverage
Professional Consultant's Liability Insurance Policy - Claims Made and Reported Coverage
Professional Environmental Consultant's Liability Insurance Policy
Professional Environmental Consultant's Liability Insurance Policy - Claims Made and Reported Coverage
Public Entity Pollution Liability - Claims Made and Reported Coverage
Real Estate Environmental Liability Insurance Policy - Claims Made and Reported Coverage ���
Remediation Stop LossS
Z Choice Pollution Liability Q�<�
Z Choice@ Real Estate Environmental Liability - Claims Made and Reported Coverage
Z Choicer"" Pollution Liability - Claims Made and Reported Coverage Pl-
Z Link® Commercial General and Pollution Liability �,�
A. If we cancel this policy by written notice to the first Named Insured for any reas othern nonpayment of
premium, we will deliver electronic notification that such policy has been cancelled to each person or organization
shown in a Schedule provided to us by the First Named Insured. Such Schedule:
STF-ENVL-1632-A CW (11/10)
Page 1 of 2
1. Must be initially provided to us within 15 days:
a. After the beginning of the policy period shown in the Declarations; or
b. After this endorsement has been added to policy;
2. Must contain the names and e-mail addresses of only the persons or organizations requiring notification that such
Coverage Part has been cancelled;
3. Must be in an electronic format that is acceptable to us; and
4. Must be accurate.
Such Schedule may be updated and provided to us by the First Named Insured during the policy period. Such
updated Schedule must comply with Paragraphs 2. 3. and 4. above.
B. Our delivery of the electronic notification as described in Paragraph A. of this endorsement will be based on the most
recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named
Insured. Delivery of the notification as described in Paragraph A. of this endorsement will be completed as soon as
practicable after the effective date of cancellation to the first Named Insured.
C. Proof of emailing the electronic notification will be sufficient proof that we have complied with Paragraphs A. and B. of
this endorsement.
D. Our delivery of electronic notification described in Paragraphs A. and B. of this endorsement is intended as a
courtesy only. Our failure to provide such delivery of electronic notification will not:
1. Extend the Coverage Part cancellation date;
2. Negate the cancellation; or
3. Provide any additional insurance that would not have been provided in the absence of this endorsement.
E. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the Schedule
provided to us as described in Paragraphs A. and B. of this endorsement.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
STF-ENVL-1632-A CW (1'61+0)
Page 2 of 2
Blanket Notification To Others Of Cancellation ZURICH
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. BAP 0146329-02 Effective Date: 08/28/2018
This endorsement modifies insurance provided under the:
Auto Dealers Coverage Form
Business Auto Coverage Form
Motor Carrier Coverage Form
A. If we cancel this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of
premium, we will deliver electronic notification that such Coverage Part has been cancelled to each person or
organization shown in a Schedule provided to us by the First Named Insured. Such Schedule:
1. Must be initially provided to us within 15 days:
a. After the beginning of the policy period shown in the Declarations; or
b. After this endorsement has been added to policy;
2. Must contain the names and e-mail addresses of only the persons or organizations requiring notification that such
Coverage Part has been cancelled;
3. Must be in an electronic format that is acceptable to us; and
4. Must be accurate.
Such Schedule may be updated and provided to us by the First Named Insured during the policy period. Such
updated Schedule must comply with Paragraphs 2., 3. and 4. above.
B. Our delivery of the electronic notification as described in Paragraph A. of this endorsement will be based on the most
recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named
Insured. Delivery of the notification as described in Paragraph A. of this endorsement will be completed as soon as
practicable after the effective date of cancellation to the first Named Insured.
C. Proof of e-mailing the electronic notification will be sufficient proof that we have complied with Paragraphs A. and B.
of this endorsement.
D. Our delivery of electronic notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy
only. Our failure to provide such delivery of electronic notification will not:
1. Extend the Coverage Part cancellation date;
2. Negate the cancellation; or
3. Provide any additional insurance that would not have been provided in the
E. We are not responsible for the accuracy, integrity, timeliness and validity of
provided to us as described in Paragraphs A. and B. of this endorsement.
All other terms, conditions, provisions and exclusions of this policy remain the same
U-CA-103-A CW (10/16)
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Blanket Notification to Others of Cancellation
or Non -Renewal
ZURICH
Policy No,
Eff. Date of Pol.
Exp. Date of Pot.
Eff. Date of End.
Producer No.
Add'I. Prem
Retum Preen.
GL00146311-02
08/28/2018
08/28/2019
08/28/2018
64966000
INCL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. If we cancel or non -renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver
notification that such Coverage Part has been cancelled or non -renewed to each person or organization shown in a
list provided to us by the first Named Insured if you are required by written contact or written agreement to provide
such notification. However, such notification will not be mailed or delivered if a conditional notice of renewal has been
sent to the first Named Insured. Such list:
1. Must be provided to us prior to cancellation or non -renewal;
2. Must contain the names and addresses of only the persons or organizations requiring notification that such
Coverage Part has been cancelled or non -renewed; and
3. Must be in an electronic format that is acceptable to us.
B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records
as of the date the notice of cancellation or non -renewal is mailed or delivered to the first Named Insured. We will mail
or deliver such notification to each person or organization shown in the list:
1. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or
2. At least 30 days prior to the effective date of:
a. Cancellation, if cancelled for any reason other than nonpayment of premium; or
b. Non -renewal, but not including conditional notice of renewal.
C. Our mailing or delivery of notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy
only. Our failure to provide such mailing or delivery will not:
1. Extend the Coverage Part cancellation or non -renewal date;
2. Negate the cancellation or non -renewal; or
3. Provide any additional insurance that would not have been provided in the absence of this endorsement.
D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided
to us as described in Paragraphs A. and B. of this endorsement.
All other terms and conditions of this policy remain unchanged.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
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U-GL-1521-A CW (10/12)
Page 1 of 1