Loading...
HomeMy WebLinkAboutAPPLIED TECHNOLOGY GROUP, INC. (4)o•.PwA-(Ay-i-wAvo)a qurvtanelez)&t)Z MAYOR Vicente Sarmiento N MAYOR PRO TEM c� Phil Bacerra N COUNCILMEMBERS David Penaloza Johnathan Ryan Hernandez .-4 Jessie Lopez Cr Nelida Mendoza Q Thai Viet Phan INSURANCE ON FILE WORK MAY PROCEED UNTIL 1 URANCE EXPIRES • Z2. Zozz CLERK OF COUNCIL DATE: CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 wvrvv Santa-ana oro (714) 647-3320 Applied Technology Group, Inc. March 1, 2022 4440 Easton Drive Bakersfield, CA 93309 Attn: Lori B. Barnes Re: No. N-2021-039 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered i Technology Group, Inc., and the City of Santa Ana, dated April 1, 2021, the tic Agreement is hereby extended for an additional one-year period, from April 1, 202: 31, 2023. Any insurance certificates are required to be extended and/or renew) extension. All other terms and conditions of the Agreement remain unchanged and effect. Sincerely, Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA 16istine Ridge� City Manager r' APPROVED AS TO FORM Sonia R. Carvalho City Attorney By: Br on Salvatierra Deputy City Attorney N-2021-039-01 CITY MANAGER Kdstine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez to by Applied : period of the through March I to cover this I full force and ATTEST Daisy Gomez, MMC Clerk of the Council APPLIED TECHNOLOGY ROUP, INC. xiB, r 16 &�Barnes President SANTA ANA CITY COUNCIL Vicanle5.n,aar. DavM Penaloxe Thai Vial Phan Mayor pWatlp Jessie Lopez Phil 9aeeoa WordI JOM1naNan an Hemantlex i d [ah WZNO Mayor Pm Tem, Word 4 eN5 NeGtla Mentloza ie•aieoo o--�—� rbMrr-asaa WeN6 a tl z a 1 M a I-rancine H. Villareal Villareal paw 202111.28 vz2ea uB'Car AcoRO� CERTIFICATE OF LIABILITY INSURANCE IDATIE(MM/DD/YYYY) 1 11/1812021 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 endorsements . PRODUCER (8K) Heffernan Insurance Brokers 7702 Meany Ave., Suite 102 Bakersfield CA 93308 CONTANAME,CTKar155 Perry PHONE E 661 48g-73HO Fix A/c Na:415-778-0301 ADDRESS: kadsspAheffins.com INSURERS AFFORDING COVERAGE NAIC I/ INSURERA: Federal Insurance Company 20281 'tense#: 0564249 INSURED APPLTEC-03 Applied Technology Group Inc 4440 Easton Drive INSURER 9: Scottsdale Indemnity Company 15580 INSURERC: Insurance Company of the West 27847 INSU RER D: Bakersfield CA 93309 NSURER E: INSURER F CERTIFICATE NUMBER: 891817176 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INAn I WV0 POLICY NUMBER POUCYEFF MWDO POLICY EXP M DD LIMITS A X COMMEROIALGENERALUABILITY CLAIMS -MADE EXI OCCUR Y 36025222WCE 7/l/2021 7/1/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO R NTED PREMISES lEa a ...... neei $1,000,000 MED EXP (Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2.000,000 $ OTHER: A AUTOMOBILE LIABILITY 2173584639 7/1/2021 7/1/2022 COMBINED ISINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS IX BODILY INJURY amident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X PROPERTYDAMAGE Per accident $ A X UMSRELLADAB X OCCUR 79894822 7/1/2021 7/1/2022 EACH OCCURRENCE $5.000.000 AGGREGATE $ 5,000,000 EXCESS LAB CLAIMS -MADE DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBEREXCLUDED? NIA Y WPL503611604 3/22/2021 3/22/2022 X STER ATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below B Professional Liability EK13406391 11/19/2021 11/19/2022 Per Claim B Agg $2,000,000 Retention $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: Agreement Number N-2021-039. City of Santa Ana, its officers, officials, employees, and volunteers are included as an additional insured (primary and non-contributory) and includes completed operations on General Liability policy per the attached endorsements, if required. Waiver of Subrogation is included on Workers Compensation policy per the attached endorsements, if required. Cancellation notice endorsement for General Liability is attached, if required. This certificate supersedes previously issued certificate on 9/18/2021. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 I'l„1thk MmBgmlentDititaat zerd REVIEWED&APPRO® V8Y; ©1988-2015 ACORD CI `I,IINCTER" F,,;,K Vj(Au( ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ' Risk Management Analyst CH U B B® Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured Additional Insured - Scheduled Person Or Organization Liability Insurance Form 80-02-2367 (Rev. 5-07) DULY 1, 2021 TO JULY 1, 2022 JULY 1, 2021 3602-52-22 WCE APPLIED TECHNOLOGY GROUP INC. FEDERAL INSURANCE COMPANY APRIL 12, 2021 Under Who Is An Insured the following provision is added Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Additional Insured - Scheduled Person Or Organization Endorsement RWeMaiugnnmtDivieiart REVIE &APPaowcl BY: ® Ruk Management Analyst CHUBB° Liability Endorsement (continued) Under Conditions, the following provision is added to the condition filled Other Insurance. Conditions Other Insurance — If you are obligated pursuant to a contract or agreement, to provide the person or organization Primary, NoncontribUtory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional Insured - Scheduled Person Or Organization Form 80-02-2367(Rev. 5-07) Endorsement Renawm 6 ArPRw®ev: Ruk Management Malys[ CH U Sao Liability Insurance • Endorsement Policy Period JULY 1, 2021 TO JULY 1, 2022 Effective Date SEPTEMBER 15, 2021 Policy Number 3602-52-22 WCE Insured APPLIED TECHNOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued SEPTEMBER 22, 2021 This Endorsement applies to the following forms: GENERAL LIABIL TY 0 Who Is An Insured 11 Under Who Is An Insured, the following provision is added. Owners, Lessees Or Persons or organizations shown in the Schedule are insureds; but they are insureds only with respect Contractors - Completed to their liability for bodily injury or property damage caused, in whole or in part, by your work Operations at the applicable location described in the Schedule performed for such person or organization and included in the products -completed operations hazard. However, • the insurance afforded to such person or organization only applies to the extent permitted by law; and • if coverage provided to the person or organization is required by a contract or agreement, the insurance afforded to the person or organization will not be broader than that which you are required by such contract or agreement to provide for the person or organization. Schedule CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA SANTA ANA, CA 92702 LiabiCty Insurance AdditionalInsured - Owners, Lessees Or Contractors- Completed Operations, Sc Form 80-02-8446(Rev. 3-17) Endorsement FtEm m&Ararovm Sr. F,ww:Ma R. VcU AAd Risk Management Analyst Liability Endorsement (continued) Liability Insurance All other terms and conditions remain unchanged. p`\ a Authorized gepresentaG`ve c.-�.�-��a Additional Insured - Owners, Lessees Or Contractors - Completed Operations, Form 80.02.8446 (Rev. 3.17) Endorsement 0 . mnugemn[[ uw= RwD&AaaR By. `® Rnk Mamgem nt Matyst C H U B B0 Policy Conditions Endorsement Policy Period JULY 1, 2021 TO JULY 1, 2022 Effective Date JULY 1, 2021 Policy Number 3602-52-22 WCE Insured APPLIED TECHNOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued APRIL 12, 2021 This Endorsement applies to the following fors: COMMON POLICY CONDITIONS Under Conditions, the following condition is added. Conditions Notice Of Cancellation When we cancel this policy we will notify person(s) or organizations(s) shown in the Schedule at To Scheduled Persons least 30 days (10 days in the event of nonpayment of premium) in advance of the cancellation date. Or Organizations When We Cancel Any failure by us to notify such person(s) or organization(s) will not: W • impose any liability or obligation of any kind upon us; or • invalidate such cancellation. Schedule Person(s) or Organization(s): CITY OF SANTA ANA RISK MANAGEMENT DIVISION Address: 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92702 Person(s)orOrganization(s): AECOM Address: 5001 E COMMERCENTER DR, #100 BAKERSFIELD, CA 93309 Policy Cond bans Notice Of Cancellation To Scheduled Persons Or Organizations Form 80-02-9780(Ed. 3-11) Endorsement iwrzmuugemq¢utneml REVIex/Ep&APPRQJn]6Y: ` L F'A�� R. V LG u[ i® Risk Management Anztyst Conditions (continued) Person(s) or Organization(s): THE CITY BAKERSFIELD, ITS MAYOR, COUNCIL, OFFICERS, AGENTS, EMPLOYEES Address: AND VOLUNTEERS, OFFICE OF RISK MANAGEMENT 1600 TRUXTUN AVE BAKERSFIELD, CA 93301 Person(s) or Organization(s): THE COUNTY OF LOS ANGELES, ITS SPECIAL DISTRICTS Fi FC EI) OFFICIALS, OFFICERS, AGENTS, EMPLOYEES AND Address: VOLUNTEERS (COLLECTIVELY COUNTY AND ITS AGENTS) DEPARTMENT OF PUBLIC WORKS ATTN: ERAYNA CHANG. BUSINESS RELATIONS AND CONTRACTS DIVISION SECTION IL 8TH FLOOR 900 SOUTH FR12MONT AVE ALHAMBRA CA 91803 All other terms and conditions remain unchanged Authorized Representative QL"' Policy Conditions Notice 01 Cancellation To Scheduled Persons Or Organizations Fonn 80-02-9780 (Ed. 3-11) Endorsement ask Managem nt Malys) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ALL CA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/22/2021 Policy No. WPL 5036116 04 Insured APPLIED TECHNOLOGY GROUP INC Insurance Company INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00) Countersigned By INSNRm Endorsement No. Premium $ INCL. RmltMmm8 madDmsion ram, RENe1vEo&pAPrRO By:: ��llr11-1F L' Ff�E IA4 VAad ®' Ruk Management Analyn Tori Pierson oae:202 032212:37:06e0700' ACCOR " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/18/2022 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 (BK) Heffernan Insurance Brokers 7702 Meany Ave., Suite 102 Bakersfield CA 93308 CONTACT NAME: Karlss Perry PHONE FAX A/C No EXt : 661-489-7380 A/c, No : 415-778-0301 ADDRESS: karissp@heffins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Federal Insurance Company 20281 License#: 0564249 INSURED APPLTEC-03 Applied Technology Group Inc 4440 Easton Drive INSURERB: Scottsdale Indemnity Company 15580 INSURER C : Insurance Company of the West 27847 INSURER D : Bakersfield CA 93309 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1521990137 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 36025222WCE 7/1/2021 7/1/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGETO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO - POLICY � ECT1:1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 2173584639 7/1/2021 7/1/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLALIAB X OCCUR 79894822 7/1/2021 7/1/2022 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE Y WPL503611605 3/22/2022 3/22/2023 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A E.L. DISEASE- EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 B Professional Liability EKI3406391 11/19/2021 11/19/2022 Per Claim &Agg $2,000,000 Retention $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Agreement Number N-2021-039. City of Santa Ana, its officers, officials, employees, and volunteers are included as an additional insured (primary and non-contributory) and includes completed operations on General Liability policy per the attached endorsements, if required. Waiver of Subrogation is included on Workers Compensation policy per the attached endorsements, if required. Cancellation notice endorsement for General Liability is attached, if required. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division -- 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE RA Moupwtott,D( Santa Ana, CA 92702 APPRovED Br 1KFir0 pW^CC^zt4aa @ 1988-2015 ACORD Ci <csurvanagen enc uencairu ne ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD C H U B Bm Liability Insurance Endorsement Policy Period JULY 1, 2021 TO JULY 1, 2022 Effective Date JULY 1, 2021 Policy Number 3602-52-22 WCE Insured APPLIED TECHNOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued APRIL 12, 2021 This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured - Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement A Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional Insured - Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement A C H U S B0 Liability Insurance 0 Endorsement • • Policy Period JULY 1, 2021 TO JULY 1, 2022 Effective Date SEPTEMBER 15, 2021 Policy Number 3602-52-22 WCE Insured APPLIED 'I'ECHNOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued SEPTEMBER 22, 2021 This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added. Who is An Insured Owners, Lessees Or Persons or organizations shown in the Schedule are insureds; but they are insureds only with respect Contractors - Completed to their liability for bodily injury or property damage caused, in whole or in part, by your work Operations at the applicable location described in the Schedule performed for such person or organization and included in the products -completed operations hazard. However, • the insurance afforded to such person or organization only applies to the extent permitted by law; and • if coverage provided to the person or organization is required by a contract or agreement, the insurance afforded to the person or organization will not be broader than that which you are required by such contract or agreement to provide for the person or organization. Schedule CTI'Y OF SANTTA ANA RISK MANAGEMENTDIVISION 20 CIVIC CENTER PLAZA SANTA ANA, CA 92702 Liability Insurance Form 80-02-8"6 (Rev. 3-17) VC Additional Insured - Owners, Lessees Or Contractors - Completed Operations, ScheWveN& APPR rveD SY^ P P �i Endorsement 76v` P�`'�`'°°` .. ._. Risl<WLan sgement Clerical Pu a _. Liability Endorsement (continued) All other terms and conditions remain unchanged. Authorized Representative Q-_C N'"" 0 • Liability Insurance Form 80-02-8446 (Rev. 3-17) Additional Insured - Owners, Lessees Or Contractors - CompOperations, Schedule WvEwED & APPRoveD Sy� leted 4� 76ve P&,woo Endorsement WWP1Ri,kM .. g—tCleri-lAide C H U B Bm Policy Conditions Endorsement Policy Period JULY 1, 2021 TO JULY 1, 2022 Effective Date JULY 1, 2021 Policy Number 3602-52-22 WCE Insured APPLIED TECHNOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued APRIL 12, 2021 This Endorsement applies to the following forms: COMMON POLICY CONDITIONS Under Conditions, the following condition is added. Conditions Notice Of Cancellation When we cancel this policy we will notify person(s) or organizations(s) shown in the Schedule at To Scheduled Persons least 30 days (10 days in the event of nonpayment of premium) in advance of the cancellation date. Or Organizations When Any failure by us to notify such person(s) or organization(s) will not: We Cancel • impose any liability or obligation of any kind upon us; or • invalidate such cancellation. Schedule Person(s) or Organization(s): CITY OF SANTA ANA RISK MANAGEMENT DIVISION Address: 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92702 Person(s) or Organization(s): AECOM Address: 5001 E COMMERCENTER DR., #100 BAKERSFIELD, CA 93309 Policy Conditions Notice Of Cancellation To Scheduled Persons Or Organizations Form 80-02-9780 (Ed. 3-11) Endorsement A Conditions (continued) Person(s) or Organization(s): THE CITY BAKERSFIELD, ITS MAYOR, COUNCIL, OFFICERS, AGENTS, EMPLOYEES Address: AND VOLUNTEERS, OFFICE OF RISK MANAGEMENT 1600 TRUXTUN AVE BAKERSFIELD, CA 93301 Persons) or Organization(s): THE COUNTY OF LOS ANGELES, ITS SPECIAL DISTRICTS ELECTED OFFICIALS, OFFICERS, AGENTS, EMPLOYEES AND Address: VOLUNTEERS (COLLECTIVELY COUNTY AND ITS AGENTS) DEPARTMENT OF PUBLIC WORKS ATTN: ERAYNA CHANG. BUSINESS RELATIONS AND CONTRACTS DIVISION SECTION II, 8TH FLOOR 900 SOUTH FREMONT AVE ALHAMBRA CA 91803 All other terms and conditions remain unchanged. Authorized Representative Policy Conditions Notice Of Cancellation To Scheduled Persons Or Organizations Form 80-02-9780 (Ed. 3-11) Endorsement A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). Schedule Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT Job Description ALL CA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/22/2022 Policy No. WPL 5036116 05 Endorsement No. Insured APPLIED TECHNOLOGY GROUP INC Premium $ INCL . Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 thwEwm & AaPRovm by: (Ed. 8-00) a ?oxe P ewooa """ Risl<WLanagement Clerical Aide INSURED Ejhjubmmz!tjhofe! EBUF!)NN0EE0ZZZZ* DFSUJGJDBUF!PG!MJBCJMJUZ!JOTVSBODF cz!Bohjf! Bohjf! UIJT!DFSUJGJDBUF!JT!JTTVFE!BT!B!NBUUFS!PG!JOGPSNBUJPO!POMZ!BOE!DPOGFST!OP!SJHIUT!VQPO!UIF!DFSUJGJDBUF!IPMEFS/!UIJT Bdfwfep! DFSUJGJDBUF!EPFT!OPU!BGGJSNBUJWFMZ!PS!OFHBUJWFMZ!BNFOE-!FYUFOE!PS!BMUFS!UIF!DPWFSBHF!BGGPSEFE!CZ!UIF!QPMJDJFT CFMPX/!!UIJT!DFSUJGJDBUF!PG!JOTVSBODF!EPFT!OPU!DPOTUJUVUF!B!DPOUSBDU!CFUXFFO!UIF!JTTVJOH!JOTVSFS)T*-!BVUIPSJ\[FE SFQSFTFOUBUJWF!PS!QSPEVDFS-!BOE!UIF!DFSUJGJDBUF!IPMEFS/ Ebuf;!3133/18/22! Bdfwfep JNQPSUBOU;!!Jg!uif!dfsujgjdbuf!ipmefs!jt!bo!BEEJUJPOBM!JOTVSFE-!uif!qpmjdz)jft*!nvtu!ibwf!BEEJUJPOBM!JOTVSFE!qspwjtjpot!ps!cf!foepstfe/ Jg!TVCSPHBUJPO!JT!XBJWFE-!tvckfdu!up!uif!ufsnt!boe!dpoejujpot!pg!uif!qpmjdz-!dfsubjo!qpmjdjft!nbz!sfrvjsf!bo!foepstfnfou/!!B!tubufnfou!po 26;54;38!.18(11( uijt!dfsujgjdbuf!epft!opu!dpogfs!sjhiut!up!uif!dfsujgjdbuf!ipmefs!jo!mjfv!pg!tvdi!foepstfnfou)t*/ DPOUBDU QSPEVDFS OBNF; GBY QIPOF )B0D-!Op*; )B0D-!Op-!Fyu*; F.NBJM BEESFTT; JOTVSFS)T*!BGGPSEJOH!DPWFSBHFOBJD!$ JOTVSFS!B!; JOTVSFE JOTVSFS!C!; JOTVSFS!D!; JOTVSFS!E!; JOTVSFS!F!; JOTVSFS!G!; DPWFSBHFTDFSUJGJDBUF!OVNCFS;SFWJTJPO!OVNCFS; UIJT!JT!UP!DFSUJGZ!UIBU!UIF!QPMJDJFT!PG!JOTVSBODF!MJTUFE!CFMPX!IBWF!CFFO!JTTVFE!UP!UIF!JOTVSFE!OBNFE!BCPWF!GPS!UIF!QPMJDZ!QFSJPE JOEJDBUFE/!!OPUXJUITUBOEJOH!BOZ!SFRVJSFNFOU-!UFSN!PS!DPOEJUJPO!PG!BOZ!DPOUSBDU!PS!PUIFS!EPDVNFOU!XJUI!SFTQFDU!UP!XIJDI!UIJT DFSUJGJDBUF!NBZ!CF!JTTVFE!PS!NBZ!QFSUBJO-!UIF!JOTVSBODF!BGGPSEFE!CZ!UIF!QPMJDJFT!EFTDSJCFE!IFSFJO!JT!TVCKFDU!UP!BMM!UIF!UFSNT- FYDMVTJPOT!BOE!DPOEJUJPOT!PG!TVDI!QPMJDJFT/!MJNJUT!TIPXO!NBZ!IBWF!CFFO!SFEVDFE!CZ!QBJE!DMBJNT/ BEEMTVCS QPMJDZ!FGGQPMJDZ!FYQ JOTS UZQF!PG!JOTVSBODFMJNJUT QPMJDZ!OVNCFS MUS)NN0EE0ZZZZ*)NN0EE0ZZZZ* JOTEXWE DPNNFSDJBM!HFOFSBM!MJBCJMJUZ FBDI!PDDVSSFODF% EBNBHF!UP!SFOUFE DMBJNT.NBEFPDDVS% QSFNJTFT!)Fb!pddvssfodf* NFE!FYQ!)Boz!pof!qfstpo*% QFSTPOBM!'!BEW!JOKVSZ% HFO(M!BHHSFHBUF!MJNJU!BQQMJFT!QFS;HFOFSBM!BHHSFHBUF% QSP. QPMJDZMPDQSPEVDUT!.!DPNQ0PQ!BHH% KFDU % PUIFS; DPNCJOFE!TJOHMF!MJNJU BVUPNPCJMF!MJBCJMJUZ% )Fb!bddjefou* BOZ!BVUP CPEJMZ!JOKVSZ!)Qfs!qfstpo*% PXOFETDIFEVMFE CPEJMZ!JOKVSZ!)Qfs!bddjefou*% BVUPT!POMZBVUPT OPO.PXOFE IJSFEQSPQFSUZ!EBNBHF % )Qfs!bddjefou* BVUPT!POMZBVUPT!POMZ % VNCSFMMB!MJBC FBDI!PDDVSSFODF% PDDVS FYDFTT!MJBC DMBJNT.NBEFBHHSFHBUF% % EFESFUFOUJPO% QFSPUI. XPSLFST!DPNQFOTBUJPO TUBUVUFFS BOE!FNQMPZFST(!MJBCJMJUZ Z!0!O BOZQ!SPQSJFUPS0QBSUOFS0FYFDVUJWF F/M/!FBDI!BDDJEFOU% O!0!B PGGJDFS0NFNCFS!FYDMVEFE@ )Nboebupsz!jo!OI* F/M/!EJTFBTF!.!FB!FNQMPZFF% Jg!zft-!eftdsjcf!voefs F/M/!EJTFBTF!.!QPMJDZ!MJNJU% EFTDSJQUJPO!PG!PQFSBUJPOT!cfmpx EFTDSJQUJPO!PG!PQFSBUJPOT!0!MPDBUJPOT!0!WFIJDMFT!!)BDPSE!212-!Beejujpobm!Sfnbslt!Tdifevmf-!nbz!cf!buubdife!jg!npsf!tqbdf!jt!sfrvjsfe* DFSUJGJDBUF!IPMEFSDBODFMMBUJPO TIPVME!BOZ!PG!UIF!BCPWF!EFTDSJCFE!QPMJDJFT!CF!DBODFMMFE!CFGPSF UIF!FYQJSBUJPO!EBUF!UIFSFPG-!OPUJDF!XJMM!CF!EFMJWFSFE!JO BDDPSEBODF!XJUI!UIF!QPMJDZ!QSPWJTJPOT/ BVUIPSJ\[FE!SFQSFTFOUBUJWF ª!2:99.3126!BDPSE!DPSQPSBUJPO/!!Bmm!sjhiut!sftfswfe/ BDPSE!36!)3127014*Uif!BDPSE!obnf!boe!mphp!bsf!sfhjtufsfe!nbslt!pg!BDPSE XPSLFSTDPNQFOTBUJPOBOEFNQMPZFSTMJBCJMJUZJOTVSBODFQPMJDZXD::1745 )Fe/9.11* XBJWFSPGPVSSJHIUUPSFDPWFSGSPNPUIFSTFOEPSTFNFOU.CMBOLFU Xfibwfuifsjhiuupsfdpwfspvsqbznfoutgspnbozpofmjbcmfgpsbojokvszdpwfsfeczuijtqpmjdz/Xfxjmmopufogpsdf pvssjhiubhbjotuuifqfstpopspshboj{bujpoobnfejouifTdifevmf/)Uijtbhsffnfoubqqmjftpomzupuiffyufouuibu zpvqfsgpsnxpslvoefsbxsjuufodpousbduuibusfrvjsftzpvuppcubjouijtbhsffnfougspnvt*/ Tdifevmf QfstpopsPshboj{bujpoKpcEftdsjqujpo BOZQFSTPO0PSHBMMDBPQFSBUJPOT XIFOSFRVJSFECZ XSJUUFODPOUSBDU Uijtfoepstfnfoudibohftuifqpmjdzupxijdijujtbuubdifeboejtfggfdujwfpouifebufjttvfevomfttpuifsxjtftubufe/ )Uifjogpsnbujpocfmpxjtsfrvjsfepomzxifouijtfoepstfnfoujtjttvfetvctfrvfouupqsfqbsbujpopguifqpmjdz/* FoepstfnfouFggfdujwf 1403303133 QpmjdzOp/XQM614722716 FoepstfnfouOp/ Jotvsfe BQQMJFEUFDIOPMPHZHSPVQJOD Qsfnjvn%JODM/ JotvsbodfDpnqboz JOTVSBODFDPNQBOZPGUIFXFTU DpvoufstjhofeCz XD::1745 )Fe/9.11* JOTVSFE