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HomeMy WebLinkAboutGRIFFITH COMPANY:,is)UR,,ANCE NOT ON FILE 1 )C,RK MAY NOT PROCEED CLERK OF COUNCIL N-2022-201 DATE: JUL 2 8 202 LICENSE AGREEMENT (,.ckwPtYvA1 fi '1 This LICENSE AGREEMENT ("Agreement") is dated as of May 31, 2022 and entered into by and between the CITY OF SANTA ANA, a charter city and municipal corporation existing under the Constitution and laws of the State of California ("City"), and Griffith Company. ("Licensee"). RECITALS A. The City is the owner of that certain real property located in the City of Santa Ana, County of Orange, California, more specifically identified as 2209 S Bristol Street, 2215 S. Bristol Street and 2219 S. Bristol Street (APN 015-194-25, APN 015-194-38 and APN 015-194- 39), as depicted on Exhibit A (collectively "License Area"). B. Licensee desires to use the License Area for purposes of storing vehicles, materials, and other construction equipment and stockpile during the License period ("Permitted Uses"). C. The City has agreed to grant Licensee a license to use the License Area, on the terms and conditions set forth in this Agreement. NOW THEREFORE, for and in consideration of the mutual covenants and agreements herein contained and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: 1. License. a. The City hereby grants to Licensee a nonexclusive license for the right to enter and use the License Area beginning on May 31, 2022, for the Permitted Uses described in Recital B, upon the terms and conditions set forth herein ("License"), subject to Licensee's performance of all of its obligations under this Agreement. This License shall remain in effect until October 31, 2022 unless extended in writing by the Executive Director of the Public Works Agency, or his or her designee. City reserves the right to immediately suspend all activities or terminate this Agreement upon Licensee' non-compliance with any of the terms or conditions of this Agreement. This Agreement is intended and shall be construed only as a revocable license to use the License Area and not as a lease or grant of any possessory or other interest. b. Hours of Operation: All work performed at the License Area shall be performed between the hours of 7:00 AM and 5:00 PM, Monday through Friday, unless otherwise provided in writing by City, such consent not to be unreasonably withheld. 2. Restoration and Clean Up. At its sole cost, Licensee shall, after use of the License Area, restore the License Area to its original condition in which it existed immediately prior to the Agreement, leave the License Area in a neat and clean condition to the sole satisfaction of the City, free of trash and debris, and remove all property and materials of Licensee. Licensee shall cause the License Area to be cleaned, with such work to be completed no later than the times specified in the License as stated in paragraph 1 above, and the License shall be extended to such time for the limited purpose of allowing the cleaning work to be completed. Page l of 5 3. Qg_mpliance with saws. Licensee shall cause all activities of Licensee under this Agreement and all activities on the License Area to be performed in compliance with all applicable federal, state, and local laws, ordinances, and regulations, and permits. 4. Maintenance. a. Licensee shall include, implement, and maintain but not be limited to the following Best Management Practices (BMPs) at the License Area: i. Waste management and Materials Pollution Control BMPs shall be implemented to prevent the contamination of stormwater by construction wastes and materials. ii, Tracking control (TC) BMPs to control off -site sediment tracking shall be implemented and maintained. iii. Sediment control (SE) BMPs shall be implemented at all locations along the site perimeter, at all operational storm drain inlets and at all non -active slopes, as appropriate. iv. Pollution prevention practices shall be implemented. v. Non-stormwater management measures to prevent illicit discharges and control stormwater pollution sources. vi. Erosion Control BMPs shall be implemented, as appropriate. vii. Wind erosion control BMPs (dust control) shall be implemented, as appropriate. Non-stormwater BMPs shall be implemented to reduce or prevent the contamination of stormwater from construction activities. b. Licensee's, at its sole cost and expense, shall: I. Install and maintain a chain link fence with green screen around the entire perimeter of the License Area; and ii. Maintain the License Area site clear of weeds, trash and debris. For specific guidance reference, reference the Construction Runoff Guidance Manual (Orange County Stormwater Program, December 2012) [littns;//media.oceov.com/s ov/ w watersheds/documents/bmp/constructionactivities.ass or the California Stormwater Quality Association (CASQA) Stormwater BMP Handbook for Construction. 5. Damaae. In the event that Licensee damages any portion of the License Area or the improvements or equipment therein, Licensee shall immediately repair the damage at Licensee's sole cost. Alternatively, the City may, at its election, repair the damage in which case Licensee shall reimburse the City for its cost within fifteen (15) days of receipt of written demand from City. 6. Licensee Parties. Licensee, together with its employees, subcontractors, agents, representatives, and all persons entering the License Area, by or through or at the direction of Licensee, are collectively referred to herein as the "Licensee Parties." Licensee shall be responsible for the Licensee Parties and shall cause the Licensee Parties to comply with the terms of this Agreement. 7. Fee, As consideration for this Agreement, Licensee shall pay City a monthly license fee of $6,000 beginning August 1, 2022 and dispose of the various stockpiles to utilize the yard. The patties understand that the Licensee has been performing extensive maintenance on the License Area after it was abandoned by the prior occupant and agree that this shall serve as consideration for the use of the property through August 1, 2022. Licensee shall continue to pay the monthly fee of $6,000 for any extension of the Agreement pursuant to Section t. S. AS -IS Condition. City makes no representation or warranty of any kind as to the condition of the License Area or any other matter relating to Licensee's use of the License Area. Licensee hereby Page 2 of 5 disclaims and waives any and all objections to the physical and other characteristics and conditions of the License Area. Licensee acknowledges and agrees that the use of the License Area will be on the basis of Licensee's own investigation of the condition of the License Area. The license to use the License Area shall be granted on an "AS -IS," "WITH ALL FAULTS" basis, without representation or warranty expressed or implied by City, or by operation of law. City expressly disclaims, which Licensee hereby acknowledges and accepts, any implied warranty of condition or fitness for a particular purpose or use. Licensee's use of the License Area shall be subject to the License Area being in a usable and safe condition at the time of Licensee's use and Licensee shall be responsible for determining whether the License Area is in such condition. In connection therewith, in the event that the License Area or access thereto is damaged or obstructed or the use by Licensee is otherwise impaired, prevented or limited, City shall have no obligation or duty to repair the damage or rectify the condition to make the License Area usable or safe. 9. Insurance. Licensee shall secure or cause its agents or contractors performing any entry onto the License Area to secure, prior to commencing any activities under this Agreement, and maintain or cause to be maintained during the term of this Agreement, insurance coverage as follows: a. Commercial General Liability Insurance. Licensee shall maintain commercial general liability insurance which 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 Licensee Parties use of the License Area, 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 and $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers 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. Worker's Compensation Insurance as required by California law. C. Comprehensive Automobile Liability Coverage, including as applicable owned, non - owned, and hired autos, in an amount of not less than $1,000,000 per occurrence, combined single ]hnit, written in an occurrence form. 10. Indemnify. Licensee shall indemnify, defend, and hold harmless City, and its respective agents, representatives, employees, subsidiaries and affiliates ("Covered Parties") from and against any and all actions, suits, claims, demands, judgments, losses, expenses, or liabilities, injuries and damages to persons and property, including death, arising out of or related to Licensee's use of the License Area, the entry by any Licensee Party on the License Area or surrounding properly, or Licensee's breach or default in the performance of any of its obligations under this Agreement; provided, however, that Licensee will not be obligated to indemnify the Covered Parties from any claims arising solely from the gross negligence or willful misconduct of a Covered Party. If any action or proceeding is brought against any Covered Party by reason of any such claim, Licensee, upon receipt of written notice from Covered Party, shall defend the same at Licensee's expense with legal counsel reasonably acceptable to Covered Party. Payment shall not be a condition precedent to recovery under any indemnification in this Agreement, and a finding of liability or an obligation to indemnify shall not be a condition precedent to the duty to defend. The provisions of this Section 10 shall survive the termination or expiration of this Agreement. 11. Miscellaneous. 11..1 Elitire Agreement, Waiver and Amendments. This Agreement incorporates all of the terms and conditions mentioned herein, or incidental hereto, and supersedes all negotiations and Page 3 of 5 previous agreements between the parties with respect to the subject matter of this Agreement. All waivers of the provisions of this Agreement most be, in writing and signed by the appropriate authorities of the parry to be charged. Any amendment or modification to this Agreement must be. in writing and executed by the appropriate authorities of the City and Licensee. 11.2 Severabilirv, If any term, provision, covenant, or condition of this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions of the Agreement shall continue in full force and effect, unless and to the extent the rights and obligations of one or both parties has been materially altered or abridged by such holding. 11.3 No Assignment, Licensee shall not assign or transfer or otherwise convey any interest in this Agreement to any party without the express prior written consent of City, which consent may be withheld in City's sole and absolute discretion. 11.4 Applicable Law, This Agreement shall be construed and enforced in accordance with the internal laws of the State of California. 11.5 Litigation_ Expenses. if either party to this Agreement commences an action against: the other parry to this Agreement arising out of or in connection with this Agreement, the prevailing party shall be entitled to recover reasonable attorneys' fees, expert witness fees, costs of investigation, and costs of suit from the losing party. 11.6 Authority. The persons executing this Agreement on behalf of the parties hereto represent and warrant to the other party that they are duly authorized to execute and deliver this Agreement on behalf of such party, and by so executing this Agreement, said party is formally bound to the provisions of this Agreement. 11.7 Notices. Any notices, requests, or approvals given under this Agreement from one party to another shall be in writing and shall be personally delivered or deposited with the United States Postal Service for mailing, postage prepaid, by certified mail, return receipt requested, to the addresses of the other party as stated in this section, and shall be deemed to have been received at the time of personal delivery or three (3) days after the deposit for mailing. Notices shall be sent to: If to Licensee: Griffith Company Attn: Dennis Gansen 3050 E. Birch Street Brea, CA 92821 If 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 11.8 Execution in Counterpart. This Agreement may be executed in several counterparts, and all so executed shall constitute one agreement binding on both of the parties hereto, notwithstanding that both parties are not signatories to the original or the same counterpart. IN WITNESS WHEREOF, City and Licensee have entered into this Agreement as of the day and year first written above. Page 4 of 5 CITY OF SANTA ANA sI st a Ridge City Manager Sonia R. Carvalho City Attorney Jose Montoya Assistant City Attorney FOR APPROVAL Nabil Saba Executive Director Public Works Agency ATTEST , Daisy Gomez ,Clerk of the Council LICENS �/ By: y�''/ Dennis Gansen Its: Division_ Division Manager Page 5 of 5 Francine R. Digitally signed by Francine R.Vill—A I- _ .. _ _ i Date: 2022.01.141 G0932-08'00' 1 ® Villareal r DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 12/18/2021 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 Los Angeles-Alliant Insurance Services, Inc. 333 S Hope St Ste 3750 Los Angeles CA 90071 CONTACT NAME: Starlene Carranza PHONE Ext: 213-406-8750 FAC,No:213-270-0984 E-MAIL ADDRESS: scarranza@alliant.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Old Republic General Insurance Corp 24139 INSURED GRIFCOM-02 INSURERB: AXIS Surplus Insurance Company 26620 Griffith Company 3050 E. Birch Street INSURERC: INSURER D Brea, CA 92821 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:555521721 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y AlCG99281805 12/31/2021 12/31/2022 EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY � PE� LOC PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y AlCA99281805 12/31/2021 12/31/2022 COEaMBINED ident SINGLE LIMIT acc $2,000,000 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 UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AlCW99281805 12/31/2021 12/31/2022 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICE R/M EMBER EXCLUDED? FY] 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 Poll/Prof Liability CM004236-03-2021 12/31/2021 12/31/2022 Each Claim/Agg $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: Griffith Job #60023, City Project #06-3510, San Lorenzo Sewage Lift Station The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives, Arch Insurance Company and JS Held, LLC are named as Additional Insured as respects to Liability arising out of work performed by the Named Insured. The insurance provided shall be primary and any other insurance maintained by the Additional Insured is excess and non-contributory. Thirty (30) Days Notice of Cancellation / Non -Renewal — Ten (10) Days Notice For Non -Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE Risk 'Division ( �e REVIEWED & APPROVED BY. © 1988-2015 ACCORD C mz , VAA44d ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ��y Risk Management Analyst POLICY NUMBER: A-1CG-992818-05 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations THE OWNER AND CONTRACTOR, IF REQUIRED BY LOCATIONS AS REQUIRED BY AN EXECUTED THE TERMS OF A WRITTEN CONTRACT THAT WAS WRITTEN CONTRACT. FULLY EXECUTED PRIOR TO THE DATE OF THE "OCCURRENCE", AND ANY OTHER PERSONS OR ENTITIES SPECIFICALLY REQUIRED BY, AND IDENTIFIED BY NAME IN, THAT SAME CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "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 for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 o NSF Risk MmagmedDMsiun z REVIEWED & APPROVED BY.- -��" Risk Management Analyst C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 o NSF Risk MwaganadDMsiun z REVIEWED & APPROVED BY.- -��" Risk Management Analyst POLICY NUMBER: A-1CG-992818-05 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations THE OWNER AND CONTRACTOR, IF REQUIRED LOCATIONS AS REQUIRED BY AN EXECUTED BY THE TERMS OF A WRITTEN CONTRACT THAT WRITTEN CONTRACT. WAS FULLY EXECUTED PRIOR TO THE DATE OF THE "OCCURRENCE", AND ANY OTHER PERSONS OR ENTITIES SPECIFICALLY REQUIRED BY, AND IDENTIFIED BY NAME IN, THAT SAME CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 o NSF Risk MmagmedDMsiun z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT. Location(s) of Covered Operations All locations as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured GRIFFITH COMPANY Policy Number A-1CG-992818-05 Endorsement No. 000 Policy Period 12 / 31 / 2 021 to 12 / 31 / 2 02 2 Endorsement Effective Date: 12 / 31 / 2 021 Producer's Name: ALLIANT INSURANCE SERVICES, INC. Producer Number: 02P20 AUTHORIZED REPRESENTATIVE CG EN GN 0029 09 06 DATE o NSF Risk Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CANCELLATION OR NON -RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART If we cancel or non -renew this policy for any reason other than non-payment, we will deliver notice of the cancellation or non -renewal to all Specified Persons or Organizations on file with us THIRTY ( 30 ) days prior to the effective date of cancellation or non -renewal. If we cancel this policy for non-payment, we will deliver notice of the cancellation to all Specified Persons or Organizations on file with us TEN ( 10 ) days prior to the effective date of cancellation. If notice is mailed, proof of mailing will be sufficient proof of notice. Named Insured GRIFFITH COMPANY Policy Number A-1CG-992818-05 Endorsement No. 000 Policy Period 12 / 31 / 2 021 to 12 / 31 / 2 02 2 Endorsement Effective Date: 12 / 31 / 2 021 Producer's Name: ALLIANT INSURANCE SERVICES, INC. Producer Number: 02P20 AUTHORIZED REPRESENTATIVE DATE o NSF Risk Division REVIEWED & APPROVED BY.- IL EN GN 0004 09 11 Page 1 of 1 z —��" Risk Management Analyst OLD REPUBLIC GENERAL INSURANCE CORPORATION ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Name of Person(s) or Organ ization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. If the person or organization shown in the schedule qualifies as an `insured' for Liability Coverage, and they have coverage as a first named insured under another policy, this policy is primary to and non-contributory with that other insurance. All other terms, conditions, and exclusions apply. Named Insured GRIFFITH COMPANY Policy Number Al CA 9928 18 05 Endorsement No. 001 Policy Period 12/31/2021 to 12/31/2022 Endorsement Effective Date: 12/31/2021 Producer's Name: Alliant Insurance Services, Inc. Producer Number: 02P20 AUTHORIZED REPRESENTATIVE CA EN GN 0044 02 12 Page 1 of 1 o NSF Risk Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CANCELLATION OR NON -RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART If we cancel or non -renew this policy for any reason other than non-payment, we will deliver notice of the cancellation or non -renewal to all Specified Persons or Organizations on file with us THIRTY ( 30 ) days prior to the effective date of cancellation or non -renewal. If we cancel this policy for non-payment, we will deliver notice of the cancellation to all Specified Persons or Organizations on file with us TEN ( 10 ) days prior to the effective date of cancellation. If notice is mailed, proof of mailing will be sufficient proof of notice. Named Insured GRIFFITH COMPANY Policy Number A-1CA-992818-05 Endorsement No. 000 Policy Period 12 / 31 / 2 021 to 12 / 31 / 2 02 2 Endorsement Effective Date: 12 / 31 / 2 021 Producer's Name: ALLIANT INSURANCE SERVICES, INC. Producer Number: 02P20 AUTHORIZED REPRESENTATIVE DATE o NSF Risk Division REVIEWED & APPROVED BY.- IL EN GN 0004 09 11 Page 1 of 1 z —��" Risk Management Analyst WORKERS, COMPENSATION AND EMPLOYERS, LIABILITY INSURANCE POLICY WC 04 06 01 A (Ed. 12-93) CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the information page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancelation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy for one or more of the following reasons: a. Non-payment of premium; b. Failure to report payroll; c. Failure to permit us to audit payroll as required by the terms of this policy or a previous policy issued by us; d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Failure to comply with Federal or State safety orders; h. Failure to comply with written recommendations of our designated loss control representatives; i. The occurrence of a material change in the ownership of your business; j. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; k. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; I. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in items (g) through (I), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. The policy period will end on the day and hour stated in the cancelation notice. This endorsement changes the policy to which it is attached 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 12/31/2021 Insured GRIFFITH COMPANY Insurance Company Policy No. A-1CW-992818-05 OLD REPUBLIC GENERAL INSURANCE CORPORATION WC 04 06 01 A (Ed. 12-93) Countersigned by Endorsement No. 000 Premium $ o Nye Risk MwaganentDMsian z REVIEWED & APPROVED BY.- -��" Risk Management Analyst WORKERS' COMPENSATION INSURANCE CERTIFICATION As required by California Labor Code Section 1860 and 1861, the Contractor certifies as follows: I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of the Code, and I will comply with such provisions before commencing the performance of the work of this contract. Signed: " Title: Dennis Gansen, Division Mana�zer Firm: Griffith Com Date: 12/17/21 o NSF Risk MwagmerdDMsiun z REVIEWED & APPROVED BY. - Risk Management Analyst