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HomeMy WebLinkAboutAJ FISTES CORPORATION (PAINTING AND WROUGHT IRON RESORTATION) INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 121S CITY OF SANTA ANA CITY CLERK CONSTRUCTION CONTRACT AGREEMENT DATE A 1 2 2024 PROJECT NO.: 24-6060& 24-6061 ° �� PAINTING AND WROUGHT IRON RESTORATION o nkcv�.A.s This CONSTRUCTION CONTRACT is made and entered into this 16th day of July, 2024 by and between the City of Santa Ana,California,a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California(hereinafter"CITY"),and AJ Fistes Corporation. (hereinafter"CONTRACTOR"). WITNESSETH: The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: 1. CONTRACTOR agrees to perform all the work and furnish all the materials at its own cost and expense necessary to construct and complete in a good and workmanlike manner and to the satisfaction of the City Engineer of the CITY, the Painting and Wrought Iron Restoration at Santa Ana Regional Transportation Center (hereinafter referred to as the "WORK OF IMPROVEMENT') identified in and in accordance with the Contract Documents prepared by the City's Public Works Agency and approved by the City Council. 2. The complete Construction Contract consists of the"Contract Documents"as defined by the Standard Specifications for Public Works Construction and which include the following: • Notice Inviting Bids • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Contract Bonds • General Provisions • Special Provisions • Technical Provisions and Project Plans • Community Workforce Agreement • Appendices In case of conflict between the Contract Documents, the precedence of documents shall be as established in the Standard Specifications for Public Works Construction. 3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the WORK OF IMPROVEMENT the sum total amount not to exceed Seven Hundred and Nineteen Thousand One Hundred Dollars and No Cents ($719,100.00), as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit"A,"and in accordance with Section 2-7.1 of the Greenbook: Standard Specifications for Public Works Construction. Page 1 of 3 The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not expressly or by implication agree that the actual amount of work will correspond therewith, hut reserves the right to increase or decrease the amount of any class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. 4. CONTRACTOR agrees to complete the WORK OF IMPROVEMENT within the time specified in the Time for Completion of Improvements section of the BID PROPOSAL (Exhibit "A") including commencing construction within the timeframe therein specified after issuance of a Notice to Proceed. 5. The CONTRACTOR will pay,and will require all subcontractors to pay, all employees on the WORK OF IMPROVEMENT a salary or wage at least equal to the prevailing salary or wage established for such work as set forth in the wage determinations for this work in accordance with applicable State and Federal law. 6. If applicable, the CONTRACTOR shall adhere to the CITY'S Community Workforce Agreement (CWA), a pre-hire collective bargaining agreement, which establishes the labor relations policies and procedures for CONTRACTOR to follow in the crafts persons employed to complete the WORK OF IMPROVEMENT as more fully described in the CW A. The CWA may be found on the City's website at: http://www.santa-ana.urg/pwa/documents/C:W A.pd 7. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful performance of the work (Performance Bond), and one in the amount of One Hundred Percent(100%) of the Contract price to guarantee payment of all claims for labor and materials furnished (Payment Bond). This Contract shall not become effective until such bonds are supplied to and approved by the CITY. 8, CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention payment, furnish a warranty performance and payment bond (Warranty Bond). Said Warranty Bond shall also be required as a condition of project acceptance. For projects up to Five Hundred Thousand Dollars($500,000),the Warranty Bond amount shall be the greater of Ten Thousand Dollars($10,000) or Twenty Percent (20%) of the final contract price. For projects above Five Hundred Thousand Dollars ($500,000),the Warranty Bond amount shall be the greater of One Hundred Thousand Dollars ($100,000) or Ten Percent(.10%) of the final contract price. 9. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions, to be approved by the CITY, 10. INDEMNIFICATION, To the fullest extent allowed by law, CONTRACTOR and its Subcontractors hereby agree to defend, indemnify, and hold harmless CITY, its City Council, boards and commissions, officers, agents, employees, representatives and volunteers (hereinafter collectively referred to as "Indemnitees"), through legal counsel acceptable to CITY, from and against any liability, claims, actions, costs, damages or losses, including reasonable costs and attorney's fees, for injury, including death to any person or damage to any property, arising directly or indirectly from, or in any manner relating to,any of the following: Page 2of3 (I) Performance or nonperformance of the Work of Improvement by CONTRACTOR or its Subcontractors of any lower tier; (ii) Performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, of any of the obligations under the Contract Documents; (iii) The construction activities of CONTRACTOR or its Subcontractors of any lower tier, either on the project site or on other properties; (iv) The payment or nonpayment by CONTRACTOR of any of its Subcontractors of any lower tier, for Work of Improvement performed on or off the project site; and (v) Any personal injury, property damage or economic loss to third persons related to and arising from the performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, of the Work of Improvement. (vi) The indemnity obligations of Subcontractors provided by this Section shall be included in all subcontract documents issued by CONTRACTOR. Nothing in the Contract Documents shall be construed to give rise to any implied right of indemnity in favor of CONTRACTOR against CITY or any other Indemnitee. IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: CITY OF SAN A ANA „a . )dia tel". NNIFER . HALL ' • ALVARO NUNEZ City C City Manager APPROVED AS TO FORM: CONTRACTOR: SONIA R. CARVALHO City Attorney AJ FISTES CORPORATION By: ,� J SE MONTOYA NA E: lA C� bat(D Assistant City Attorney TITLE \.ti RECOMMENDED FOR APPROVAL: Digitally signed by S Nab i I Saba Date:202 07.0211:46:218 aba -07'00' NABIL SABA, PE Executive Director Public Works Agency Page 3 of 3 Exhibit A CITY OF SANTA ANA Addendum No.3 PROPOSAL Project Nos. 24-6060 & 24-6061 PROJECT NO,;24-6060&24-6061 SANTA ANA REGIONAL TRANSPORTATION CENTER PAINTING & WROUGHT IRON RESTORATION BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: cS 10t'T10`l REQUIREMENT: The undersigned bidder declares that they have carefully examined the location of the proposed work, that they have examined the Contract Documents in its entirety and hereby proposes to furnish all material and do all the work required to complete the said work in accordance with said plans (if any) and the specifications for the unit price(s) or lump sum(s) set forth in the following schedule: Item Description Qty — Unit Unit Price Amount 1 SARA:Painting Improvements - LS $ 07 oo /O? yt Wrought t._ vane �q p�� 2 SARTC retrot,Fencing Irripmvaments I LS $Pig ©°4 $ 19�.a ` / (includes curb rr lairs /7"'( 3 SARTC wrought Iron Fencing Sections LS $ .._... Replacement 50 eo 504 v- 4 Railroad Rigia of Entry/Flagging • t t.S SI 00,1100 $ itoteco 5 Construction Permit t LS $5,000 $ MO TOTAL BAID $ 51O 13° ADD ALTERNATES 1 Paint Parking Gnroge 1 I S S,_02 o0 $ Zd2 S _2 _W Paint Undersides of Collonades I LS S ,r S" $ vitro __ "T 3 Capital Repair �I 1.S $ $ . ... TOTAL ADD ALTERNATE BID $ eijni `� TOTAL COST(BASE BID+ ADD ALTERNATES) $ '-7 tt The lowest responsible bidder shall be selected based on the total base hid. The City reserves the right to award the Base Bid,and any, all, or none of the add-alternate bid items(if any). * The quantity for this bid item is shown for bid comparison only. This bid item shall not be subject to the"250%"limit as stated in Section 7-3.5 of the Standard Specifications. The actual P-I of P-IS CITY OF SANTA .ANA Addendum No.3 Project Nos. 24-6060 & 24-6061 PROPOSAL PROJECT NO.:24-6060 & 24-6061 SANTA ANA REGIONAL TRANSPORTATION CENTER PAINTING & WROUGHT IRON RESTORATION amount ft r this item will be dictated by the actual quantity used, and the Agency reserves the right to increase or decrease the quantity of this item accordingly. 1' This bid item is considered a Specialty Item per Section 3-2 of the Standard Specifications. TIME FOR COMPLETION OF IMPROVEMENTS AND LIOU1pATEp DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within number 100 working days after the commencement date stated in the Notice to Proceed. Upon issuance of the Notice to Proceed, Contractor shall immediately place order for long-lead time items. Work shall he completed by December 2024. The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall he $3,600 per calendar day. Name of Firm l ' 5 C Cef Signature of BIDDER Title ai5(CJSal3tjr` 5 C car Cs div (If an inidual, so state. If a firm or co-partnership, state the firm name and give the names of all individual co-partners composing the firm. If a corporation, state legal name of corporation, and names of President, Secretary, Treasurer and Manager, thereof.) P-2 of P-I S A`ORD CERTIFICATE OF LIABILITY INSURANCE DAT7/z3/ZDIY) 024 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 CONTAC- Burnham WGB Insur. e Solutions NAME: KilSt erez • a Q • PHONE CA Insurance Licens A697 1 • E-MA L ''c'7 i 9 I t o I I s Ta 1 t e�1 15901 Red Hill Ave ADORES: _K is en.pere n. gbi com Tustin CA 92780 INSURER(S)`a FFORDING COVERAGE NAIC# INSURER E F anc:/,rrS',j'j die • ,a, gCeved o INSURED AJFIS-1 INSURE)" 3: Inn F anc':I r A.J.Fistes Corporation 1244 N.Gaffey Street INSUR' :C:E -rest National Insurance Corn 10120 San Pedro CA 90731 INSU I ERE. Gr 3 'G .nc i IIAI : F: ` L� COVERAGES C: 'TIFICA 'ER:47 fl al al RE 0. NUM: : THIS IS TO CERTI THAT E - IE SU'. NCE . B- .V- ISSU .e , UR D • • :OKG ' T•E -•V i l RIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COt )IT' ,N OF ANY CONT • .R I R DOC. ITH -P CT T,. . THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AF'JRDED 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 POLICY EXP LIMITS (MMIDD/YYYY) (MMIDDIYYYYI C X COMMERCIAL GENERAL LIABILITY Y CF1GL00279241 4/19/2024 4/19/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y 975530280 6/8/2024 12/8/2024 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS Xr HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ D UMBRELLA LIAB X OCCUR EXC5201094 4/19/2024 4/19/2025 EACH OCCURRENCE $5,000,000 _ X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION Y 7600023383241 6/30/2024 6/30/2025 X PER OTH- AND EMPLOYERS'LIABILITY YINri STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Agreement Nos.A-2017-172 and A-2017-290,SARTC Painting The City of Santa Ana,its officers,employees,agents,and representatives are included as Additional Insured with respect to General and Auto Liability if required by written contract and subject to terms,conditions and exclusions of the policy.Coverage is provided on a Primary&Non-Contributory basis on General and Auto Liability if required by written contract and subject to terms,conditions and exclusions of the policy.A Waiver of Subrogation in favor of The City of Santa Ana,its officers,employees,agents,and representatives applies to Workers Compensation if required by written contract,and subject to terms, conditions,and exclusions of the policy.30-day notice of cancellation,except for nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PRC\ ' RbltManagementDivialon 1 Risk Management Division �9 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE z;' 1. REVIEWED&APPROVED BY: Santa Ana CA 92702 —� -. °!A 111 i c� A Aug ' I CM' Risk Management Specialist Ti- ..., ©1988-2015 ACORD / ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: 975530280 Form 2366 (02/11)M_CL Blanket Additional Insured Endorsement This endorsement modifies insurance provided by the Commercial Auto Policy,Motor Truck Cargo Legal Liability Coverage Endorsement, and/or Commercial General Liability Coverage Endorsement, as appears on the declarations page.All terms and conditions of the policy apply unless modified by this endorsement. If you pay the fee for this Blanket Additional Insured Endorsement, we agree with you that any person or organization with whom you have executed a written agreement prior to any loss is added as an additional insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to such additional insured only as a person or organization liable for your operations and then only to the extent of that liability. This endorsement does not apply to acts, omissions, products,work, or operations of the additional insured. Regardless of the provisions of paragraph a.and b. of the "Other Insurance" clause of this policy, if the person or organization with whom you have executed a written agreement has other insurance under which it is the first named insured and that insurance also applies,then this insurance is primary to and non-contributory with that other insurance when the written contract or agreement between you and that person or organization, signed and executed by you before the bodily injury or property damage occurs and in effect during the policy period, requires this insurance to be primary and non- contributory. In no way does this endorsement waive the "Other Insurance"clause of the policy, nor make this policy primary to third parties hired by the insured to perform work for the insured or on the insured's behalf. ALL OTHER TERMS, LIMITS,AND PROVISIONS OF THE POLICY REMAIN UNCHANGED. os \,, Risk MmtsgemattDmsion `� y REVIEWED&APPROVED BY 3 '' �ifU.1kJ''. Affz AcavuLa ._ ®. Risk Management Specialist .' PROGRESS/YE' commERC/AL Policy Number: 975530280 Certificate Number 34723E4P280 This policy is primary and non-contributory as to Certificate Holder regardless of whether Holder is a named insured of any other policy. Blanket Waiver of Subrogation in favor of the certificate holder,but only if party to a written waiver agreement executed by the named insured,as required by contract,prior to the occurrence of any loss.The certificate holder is an additional insured if required by written contract executed by the named insured prior to the occurrence of any loss,per blanket Al endorsement. Please be advised we will not notify certificate holders in the event of mid-term cancellation. Form 5241(05/16) \ I iale gentext _f'iILt.l iEW D APPROVED 3` �3 REVIEWED&APPROVl37 6Y: of• " A 11,444 issumas Risk Management Specialist Policy Number: CF1 GL00279241 CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Location And Description Of Or Organization(s) Completed Operations Any person or organization when you have agreed in All locations and completed operations for a written and executed contract, prior to an which you have agreed in a written and "occurrence", that such person or organization be executed contract prior to an "occurrence." added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, required by a contract or agreement, the most by "your work" at the location designated and we will pay on behalf of the additional insured is described in the Schedule of this endorsement the amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable limits of However: insurance; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the by law; and applicable limits of insurance. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All other terms and conditions of this Policy remain unchanged. Risk Management Division , ^ Re MIVEQ&APPRovm BY- ft1 }t•t.�i¢A4Z4 o CG 20 37 12 19 © Insurance Services Office, 018 ® Inc.,. Management t��-r Risk Mana Policy Number: CF1 GL00279241 CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization when you have agreed in All locations for which you have agreed in a a written and executed contract, prior to an written and executed contract prior to an "occurrence", that such person or organization be "occurrence". added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) additional insureds, the following additional or organization(s) shown in the Schedule, but exclusions apply: only with respect to liability for "bodily injury", "property damage"or"personal and advertising This insurance does not apply to "bodily injury" injury" caused, in whole or in part, by: or"property damage"occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on work, on the project (other than service, your behalf; maintenance or repairs) to be performed by in the performance of your ongoing operations or on behalf of the additional insured(s) at for the additional insured(s) at the location(s) the location of the covered operations has designated above. been completed; or However: 2. That portion of"your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured only applies to the extent permitted intended use by any person or organization by law; and other than another contractor or eprovided to the additional subcontractor engaged in performing 2. If coverage operations for a principal as a part of the insured is required by a contract or same project. 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. oa ,, Risk ManagenatDivision irris _ RonEWEQ&APPRav®By:CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Risk Management Specialist / t 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. All other terms and conditions of this Policy remain unchanged. \ / ,,.,°_„.,, Risk Mar�¢geneidDnision _• Rt nEwED&APPROVED BY: 3. '; mums Risk Management Specialist / \ CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 Policy Number: CF1GL00279241 IL001711 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation b. Give you reports on the conditions we find; 1. The first Named Insured shown in the Declara- and tions may cancel this policy by mailing or deliv- c. Recommend changes. ering to us advance written notice of cancella- 2. We are not obligated to make any inspections, tion. surveys, reports or recommendations and any 2. We may cancel this policy by mailing or deliv- such actions we do undertake relate only to in- ering to the first Named Insured written notice surability and the premiums to be charged. We of cancellation at least: do not make safety inspections. We do not un- a. 10 days before the effective date of cancel- dertake to perform the duty of any person or lation if we cancel for nonpayment of pre- organization to provide for the health or safety mium; or of workers or the public.And we do not warrant that conditions: b. 30 days before the effective date of cancel- lation if we cancel for any other reason. a. Are safe or healthful; or 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last mailing address known to standards. us. 3. Paragraphs 1. and 2. of this condition apply not 4. Notice of cancellation will state the effective only to us, but also to any rating, advisory, rate date of cancellation. The policy period will end service or similar organization which makes in- on that date. surance inspections, surveys, reports or rec- ommendations. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we 4. Paragraph 2. of this condition does not apply to cancel, the refund will be pro rata. If the first any inspections, surveys, reports or recom- Named Insured cancels, the refund may be mendations we may make relative to certifica- less than pro rata. The cancellation will be ef- tion, under state or municipal statutes, ordi- fective even if we have not made or offered a nances or regulations, of boilers, pressure ves- refund. sets or elevators. 6. If notice is mailed, proof of mailing will be suffi- E. Premiums cient proof of notice. The first Named Insured shown in the Declara- B. Changes tions: This policy contains all the agreements between 1. Is responsible for the payment of all premiums; you and us concerning the insurance afforded. and The first Named Insured shown in the Declara- 2. Will be the payee for any return premiums we tions is authorized to make changes in the terms pay. of this policy with our consent. This policy's terms F. Transfer Of Your Rights And Duties Under This can be amended or waived only by endorsement Policy issued by us and made a part of this policy. Your rights and duties under this policy may not C. Examination Of Your Books And Records be transferred without our written consent except We may examine and audit your books and re- in the case of death of an individual named in- cords as they relate to this policy at any time dur- sured. ing the policy period and up to three years after- If you die, your rights and duties will be transferred ward. to your legal representative but only while acting D. Inspections And Surveys within the scope of duties as your legal represen- 1. We have the right to: tative. Until your legal representative is appointed, anyone having proper temporary custody of your a. Make inspections and surveys at any time; property will have your rights and duties but only with respect to that propel Risk Management Division . REVIEWED&APPROVED BY: ® Risk Management Specialist S IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 Policy Number: CF1GL00279241 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and / Risk Mar*gententDivision (IV REVIEWED&APPROVED BY: 0 °' A+•p Actocio Risk Management Specialist CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2%of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 06/30/2024 Policy No. 7600023383241 Endorsement No. 001 Insured: A.J.Fistes Corporation Premium$ INCL. Insurance Company:Everest Premier Insurance Company Countersigned By: Risk Martagenetti Division . _ REVIEWED&APPROVED BY: -1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. al .y�1''n' A ev�elo From the WCIRB's California Workers'Compensation Insurance Forms Manual-1999. �� Risk Management Specialist s CITY OF SANTA ANA = ♦ =tylb PUBLIC WORKS AGENCY * CONTRACT CHANGE ORDER // Project Number Project No. 24-6060, 24-6061 SARTC PAINTING AND WROUGHT Change Order Number 1 IRON RESTORATION To A.J. FISTES Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE:THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated,rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY EXTRA WORK AT AGREED PRICE 1. Prep. Prime and Paint all Lamps at SARTC Black-155 total per PCO#01 dated September 4, 2024. AGREED PRICE =$32,366.32 2. Prep, Prime and Paint all Lamp Poles @ SARTC East Parking Lot Black-66 total per PCO#2 dated September 5, 2024. AGREED PRICE =$15,535.83 3. Prep, Primer added trim at tower and accent columns at Architectural Building PCO #3 dated September 17, 2024 AGREED PRICE =$6,473.26 4. Prep, Primer and Paint parking structure mesh gates & on stairway and staircase work per PCO#5 dated September 25, 2024 AGREED PRICE =$14,888.51 5. Prep, Primer and paint bus stoppers (29 brown and 10 yellow) per PCO #6 dated September 25, 2024. AGREED PRICE =$4.438.81 6. Prep, primer and paint interior Bridge in the parking structure per PCO #7 dated September 27, 2024 AGREED PRICE =$3,236.63 7. Prep, primer and paint interior structure and stairwells at train bridge per PCO #8 dated September 27,2024 AGREED PRICE =$8,785.14 8. Prep, primer and paint 2nd floor courtyard at tower hallways per PCO #9 September 27, 2024 AGREED PRICE =$7,767.92 TOTAL AGREED PRICE = $93,492.42 Page 1 of 2 7.44.1T r CITY OF SANTA ANA _ _ >� PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project No.. 24-6060, 24-6061 SARTC PAINTING AND Change Order Number 1 WROUGHT IRON RESTORATION To A.J.1tS9 AS Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract, NOTE:THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated,rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE $ INCREASE $ 93,492.42 By reason of this order the CONTRACT TIME completion will be adjusted as follows: Zero(01 Workinu Days We the undersigned contractor have given careful consideration to the change proposed and hereby agree,if this proposal is approved.that we will provide all equipment,furnish all materials,except as may otherwise be noted above,and perform all service necessary for the work above specified,and will accept as full payment therefor the prices shown above. Accepted,Date k Col or A.J. Fistas. By Qa1c\.Q1\7' Approval recommende M o. G ?�� Date k O I t 15 f 2— PUBLIC WORKS A NCY EXECUTIVE DIR LAA ei. 5 Approved bye Dale /,I�/66 /202./(7 CI MANAGEF? Attest: W ' i Dale 46\.P60..`l /TY CLERK � Page 2 of 2 Project #24-6060, 24-6061 SARTC Painting & Wrought Iron Fencing Contract Funding Authorization/Expenditures Summary Council Authorization Construction Contract $ 719,100.00 Construction Contingency $ 370,035.00 Total $ 1,089,135.00 Staff Authorized Expenditures Construction Contract $ 719,100.00 Change Order 1 $ 93,492.42 Total $ 812,592.42 Autual Expenditures Progress Payment #1 $ 100,385.00 Total $ 100,385.00 ' CITY OF SANTA ANA PUBLIC WORKS AGENCY • n r ,f,, CONTRACT CHANGE ORDER Project Number Project No. 24-6060, 24-6061 SARTC PAINTING AND WROUGHT Change Order Number 2 IRON RESTORATION _ To A.J. FISTES CORPORATION Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not Included in the plans and specifications on this contract. NOTE:THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL.APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated,rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time, Change requested by PUBLIC WORKS AGENCY EXTRA WORK AT AGREED PRICE 1. Prep. Prime and Paint train bridge stairwells inside and outside and bridge exterior area per PCO #10 dated 10/22/2024, TOTAL AGREED PRICE= $40,708,58 Page 1 of 2 • CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project No.. 24-6060, 24-6061 SARTC PAINTING AND Change Order Number 2 WROUGHT IRON RESTORATION To A.J. FISTES CORPORATION Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE:THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE $ INCREASE $ 40,708.58 By reason of this order the CONTRACT TIME completion will be adjusted as follows: Zero(0).Working Days We the undersigned contractor have given careful consideration to the change proposed and hereby agree,if this proposal is approved,that we will provide all equipment,furnish all materials,except as may otherwise be noted above,and perform all service necessary for the work above specified,and will accept as full payment therefor the prices shown above. Accepted,Date (j Z^��J" ntractor A.J. Fistas. By Title 7 j t Q \ Z ,(&,1 Approval recommended byg?__ a Date PUBLIC WORKS AGENCY EXECUTIVE DIRECTOR for Approved by 1A" Date iZ CITY MA NAGER Minh Thai Assistant City Manages Attest -,� ` _ Date 3trlla�5 • Page 2 of 2 Project It 24-6060, 24-6061 SARTC Painting & Wrought Iron Fencing Contract Funding Authorization/Expenditures Summary Council Authorization Construction Contract $ 719,100.00 Construction Contingency $ 370,035.00 0 Total $ 1,089,135.00 Staff Authorized Expenditures Construction Contract $ 719,100.00 Change Order 1 $ 93,492.42 Change Order 2 $ 40,708.58 Total $ 853,301.00 Actual Expenditures Progress Payment 1 $ 100,385.00 Progress Payment 2 $ 236,045.00 Progress Payment 3 $ 172,725.79 Progress Payment 4 $ 55,700.00 Total $ 564,855.79 Y:\ParksFleetf edifies\projects_FACILITIES\SARTC\24-6060,24-6061 SARTC Wrought Iron Fencing\2 Construction\07.Change Order\24-6060,24-6061_Change Order Summary CITY OF SANTA ARIA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER Project Number Project No. 24-6060, 24-6061 SARTC PAINTING AND WROUGHT Change Order Number 3 IRON REa�TlRA1IrJN _ To A.J. FISTES CORPORATION You are hereby directed to maka the herein changes Irom the plans and spsclflcatton5 or do the following described work not included In the plans and specifications on this contract. NOTE THIS CHANGE ORDER I5 NOT EFFECTIVE UNTli.APPROVED BY THE CITY COUNCIL,OR CITY MANAGER. Uniess otherwise stated,rates for renIA of equiprneni coves only such Ilmo as equipment is actually used and no allowance will be made for idle time. Chanedo requested by PUBLIC WORKs AGENCY EXTRA 1CV1CV RK&T AGREED PRICE 1, Replacement of 143 original to buiUng exterior signs with new up to standard signs to ensure the safety, accessibility and overall quality of the train station per PCO #2404-018-014 dated 03/2412026. AGREED_P.Rip �33 48 U 7. Preparation Prime and Paint Northwest Column and Fence by Santa Ana Blvd/Santiago Street intersection PCO#2404-018-013 dated 03/29/2025. AGREED .$5,134.81 Wage 1 of 2 CITY OF SANTA ANA PUBLIC WORKS AGENCY CONTRACT CHANGE ORDER R Project Nuumber Project No.. 24-6060, 24-6061 SARTC PAINTING AND Change Order Number 3 WROUGHT IRON RESTORATION T To A.J. FISTES CORPORATION Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE:THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated,rates for rental of equipment cover only such time as equipment is actually used and no allowance grill be made for idle time. Change requested by PUBLIC WORKS AGENCY The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor,all Subcontractors,and all Suppliers for all work performed per this change order,including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract, The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE OROER: DECREASE $ -- _--__r- INCREASE $ 38,682.93 By reason of this order the CONTRACT TIME completion will be adjusted as follows: Zero(30)Working Days We the undersigned contractor have given careful consideration to the change proposed and hereby agree,if this proposal is approved,that we will provide all equipment.furnish all materials,except as may otherwise be noted above.and perform all service necessary for the work above specified,and will accept as full payment therefor the prices shown above. Accepted,Dal �•g 2b2S Contractor A.J. Fistes. By Title Approval recommended by 1a- Date 4I 2 4-1�5 9-�U-eucwoRKs ENCYExEcurly CroR Approved by U% Date J — TY MA Attest. _T _ _ !]ate i C7rYCLERK —) `+ � Page 2 of 2 Project # 24-6060, 24-6061 SARTC Painting & Wrought Iron Fencing Contract Funding Authorization/Expenditures Summary Council Authorization Construction Contract $ 719,100.00 Construction Contingency $ 370,035.00 Total $ 1,089,135.00 Staff Authorized Expenditures Construction Contract $ 719,100.00 Change Order 1 $ 93,492.42 Change Order 2 $ 40,708.58 Change Order 3 $ 38,682.93 Total $ 891,983.93 Actual Expenditures Progress Payment 1 $ 100,385.00 Progress Payment 2 $ 236,045.00 Progress Payment 3 $ 172,725.79 Progress Payment 4 $ 55,700.00 Progress Payment 5 $ 80,280.00 Progress Payment 6 $ 38,236.63 Progress Payment 7 $ 56,900.00 Progress Payment 8 $ 113,028.58 Total $ 853,301.00 Aca CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) 12/5r2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Burnham WGB Insurance Solutions NAME: Kristen Perez CA Insurance License OF69771 PHONE Ex ,714-505-700fl FAX 1 714-573-1770 15901 Red Hill Avenue E-MAIL ADDREss: kristen. erez w bib.com Tustin CA 92780 INSURERIS AFFORDING COVERAGE NAIL# INSURER A: Everest Premier Insurance Comp 16045 INSURED AJFfS-1 INSURER B:Great American Insurance Com p a 16691 A.J. Fistes Corporation 1244 N. Gaffey Street INSURERC:IGeneral Insurance Cor or 20095 San Pedro CA 90731 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:1809987216 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 TYPE OF INSURANCE ADDL SUBR POLICY I POLICY EXP IPOLICY NUMBER MMIDD)YYYY MMIODlYYYY LIMITS C X COMMERCIAL GENERAL LIABILITY Y CLP3749664 1014/2024 6/3012025 EACH OCCURRENCE $2,000,000 CLAIMS-MADE I X I OCCUR DAMAGE TO RENTED PREMISES Ea occurrent® S 100,000 MED EXP(Any One person) S 5,000 PERSONAL&ADV INJURY 52,000,D00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY PRO- JECT D LOC PRODUCTS-COMPlOP AGG $2,040,000 OTHER: $ C AUTOMOBILE LIABILITY Y CAP3749663 10)4I2024 6/30/2025 COMBINED SINGLE LIMIT $2,000,000 Ea acciden€ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY( ) Per accident $ HIRED NON-OWNED -PROPERTY DAMAGE $ X1AUTOS ONLY AUTOS ONLY Per act€dent H I COmPICOII Ded. $1,000 B UMBRELLA N OCCUR EXC5201094 4/19/2024 6/3012025 EACH OCCURRENCE $7,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $7,000,000 DIED RETENTION$ 3 A WORKERS COMPENSATION Y 7600023383241 6/30/2024 6/30/2025 X I SEATUTE ERH AND EMPLOYERS'LIABILITY Y)N ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? D N!A (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS f LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Agreement Nos.A-2017-172 and A-2017-290,SARTC Painting The City of Santa Ana, its officers,employees,agents,and representatives are included as Additional Insured with respect to General and Auto Liability if required by written contract and subject to terms,conditions and exclusions of the policy.Coverage is provided on a Primary&Non-Contributory basis On General and Auto Liability if required by written contract and subject to terms,conditions and exclusions of the policy.A Waiver of Subrogation in favor of The City of Santa Ana,its officers,employees,agents,and representatives applies to Workers Compensation if required by written contract,and subject to terms, conditions,and exclusions of the policy.30-day notice of cancellation,except for nonpayment of premium. APPROVED CERTIFICATE HOLDER CANCELLATION By Cynthia Mora at 11:43 am,Dec 13, 2024 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 c01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD BITOO GENERAL INSURANCE CORPORATION CAP3749663 BITCO NATIONAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE-AUTOMOBILES The following modifies insurance provided under: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. 1 - Broad Form Named Insured 11 - Bodily Injury Extension 2- Automatic Waiver of Subrogation 12- Hired Auto Physical Damage 3- Automatic Additional Insured 13- Enhanced Supplementary Payments 4- Primary and Nonoontributory-Other Insurance 14- Fellow Employee Coverage for Designated Condition Positions 5- Unintentional Failure to Disdose Hazards 15- Physical Damage—Transportation Expenses 6- Extended Notice of Cancellation, Trion-Renewal 16- Rental Reimbursement Coverage 7- When We Do Not Renew 17- Loan/Lease Gap Coverage 8- Notice of Knowledge of Accident or Loss 18- Accidental Air Bag Discharge Coverage 9- Employees as Insured 19- Glass Repair—Waiver of Deductible 10- Employee Hired Autos 1. BROAD FORM NAMED INSURED SECTION II.A 1.-WHO IS AN INSURED - Paragraph d. is added: d. Any organization you newly acquire or form, except for a partnership, joint venture or limited liability company, and over which you maintain rAority ownership or interest (51%or more) or for which you have assumed the active management, will qualify as a Named Insured if there is no other similar insurance available to that organization. However, coverage under this provision is only afforded until the end of the policy period or the 12-month anniversary of the policy inception date, whichever is earlier. 2 AUTOMIATIC WAIVER OF SUBROGATION Section IV— Business ALAo Conditions, Paragraph A5., Transfer of Rights of Recovery Against Others to Us, is deleted and replaced with the following: a If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for damages under this coverage form. AP-0401 (10/17) 1 3. AUMMTICADDMONAL INSURED SECTION II — WHO IS AN INSURED, Paragraph All, is amended to include as an "insured" any person or organization who is required by written contract or agreement to be an additional insured on your policy, but only with respect to liability arising out of operations performed by you or on your behalf for the additional insured. 4. PRIGARY NONCONTRIBUTORY-OTHER INSURANCE CONDM ON The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Forms Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an"insured"under your policy provided that: 1. Such"insured" is a Named Insured under such other insurance;and 2 You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such"insured". 5. UNIWBT ONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. 6. E) ENDED NOTICE OF CANCELLATION,NON-RENEWAL The COMIVION POLICY CONDITIONS , Item A2b. is deleted and replaced with the following: A2b. 60 days before the effective date of the cancellation if we cancel for any other reason. 7, WHEN WE DO NOT RENEW SECTION IV—BUSINESS AUTO CONDITIONS , is amended to add Item 8.9.: a If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a above, it is agreed that you may extend the period of this policy for a maximum additional sixty (60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one-time sixty-day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9. a above. 8. NOTICE OF KNCM LEDGE OF ACCIDENT OR LOSS SECTION IV-BUSINESS AUTO CONDTIONS , Item Ala. is deleted and replaced with the following: 2. Duties in the Event of Accident,Claim Suit or Loss: a You must see to it that we are notified of an "accident", "claim', "suit" or 'loss" which may result in a claim as soon as practicable after the "occurrence" has been reported to you, a partner, a member, an officer, or an employee designated to give notice to us. Notice should include: (1) How, when and where the"accident"or'loss"occurred; AP-0401 (10/17) -2- CLP3749664 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUILDERS EXTENDED LIABILITY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that the provisions listed below apply only upon the entry of an 0 in the box next to the caption of such provision. A. 0 Partnership and Joint Venture Extension N. a Construction Project General Aggregate Limits B. 0 Contractors Automatic Additional Insured Coverage-Ongoing Operations O, 0 Fellow Employee Coverage C. F_X]Automatic Waiver of Subrogation P. EK Property Damage Liability-Elevators D. 0 Extended Notice of Cancellation, Q. F7X Care, Custody or Control Nonrenewal R. 0 Concrete Rework Labor Reimbursement E. 0 Unintentional Failure to Disclose Hazards Coverage F. 1 Broadened Mobile Equipment S.17— Lost Key Coverage G, FX Personal and Advertising Injury- T. 0 Electronic Data Liability Coverage Contractual Coverage U. 0 Consolidated Insurance Program Residual H. 0 Nonemployment Discrimination Liability Coverage L F-] Liquor Liability V. 0 Automatic Additional Insureds-Managers or Lessors of Premises J. 0 Broadened Conditions W. 0 Automatic Additional Insureds-State or K. 0 Automatic Additional Insureds-Equipment Governmental Agency or Political Leases Subdivisions-Permits or Authorizations L. F_X1 insured Contract Extension--Railroad X. OX Contractors Automatic Additional Insured Property and Construction Contracts Coverage-Completed Operations M. 0 Turnkey Jobs-Coverage For Alienated Y. FRI Additional Insured-Engineers, Architects Premises or Surveyors A. PARTNERSHIP AND JOINT VENTURE EXTENSION The following provision is added to SECTION II -WHO IS AN INSURED: The last full paragraph which reads as follows: No person or organization is an insured with respect to the conduct of any current or past partnership,joint venture or limited liability company that is not shown as a Named Insured in the Declarations. GL-3084 (10/19) -1- is deleted and replaced with the following: With respect to the conduct of any past or present joint venture or partnership not shown as a Named Insured in the Declarations and of which you are or were a partner or member, you are an insured, but only with respect to liability arising out of"your work" on behalf of any partnership or joint venture not shown as a Named Insured in the Declarations, provided no other similar liability insurance is available to you for"your work" in connection with your interest in such partnership or joint venture. B. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE—ONGOING OPERATIONS SECTION II — WHO IS AN INSURED is amended to Include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, 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 project(s) designated in the written contract. 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. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. C. AUTOMATIC WAIVER OF SUBROGATION Item 8. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 8. Transfer of Rights of Recovery Against Others to Us and Automatic Waiver of Subrogation. a. If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. GL-3084 (10/19) -2- b. If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of"your work"for that person or organization. D. EXTENDED NOTICE OF CANCELILATRON, NONRENEWAL Item A.2.b. of the COMMON POLICY CONDITIONS, is deleted and replaced with the following: A.2.b. 60 days before the effective date of the cancellation if we cancel for any other reason. Item 9. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 9. WHEN WE DO NOT RENEW a. If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a. above, it is agreed that you may extend the period of this policy for a maximum additional sixty(60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one time sixty day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9.a. above. E. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. F. BROADENED MOBILE EQUIPMENT Item 12.b. of SECTION V- DEFINITIONS, is deleted and replaced with the following: 12.b. Vehicles maintained for use solely on or next to premises, sites or locations you own, rent or occupy. G. PERSONAL AND ADVERTISING INJURY-CONTRACTUAL COVERAGE Exclusion 2.e. of SECTION I, COVERAGE B, is deleted. H. NONEMPLOYMENT DISCRIMINATION Unless "personal and advertising injury" is excluded from this policy: Item 14. of SECTION V- DEFINITIONS, is amended to include: "Personal and advertising injury" also means embarrassment or humiliation, mental or emotional distress, physical illness, physical impairment, loss of earning capacity or monetary loss, which is caused by"discrimination." SECTION V-DEFINITIONS, is amended to include: "Discrimination" means the unlawful treatment of individuals based on race, color, ethnic origin, age, gender or religion. GL-3084 (10/19) -3- Item 2. Exclusions of SECTION I, COVERAGE B, is amended to include: "Personal and advertising injury" arising out of "discrimination" directly or indirectly related to the past employment, employment or prospective employment of any person or class of persons by any insured. "Personal and advertising injury" arising out of"discrimination" by or at your, your agents or your "employees"direction or with your, your agents or your"employees"knowledge or consent. "Personal and advertising injury" arising out of "discrimination" directly or indirectly related to the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any dwelling, permanent lodging or premises by or at the direction of any insured. Fines, penalties, specific performance or injunctions levied or imposed by a governmental entity, or governmental code, law, or statute because of"discrimination." I. LIQUOR LIABILITY Exclusion 2.c. of SECTION I, COVERAGE A, is deleted. J. BROADENED CONDITIONS Items 2.a. and 2.b. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, are deleted and replaced with the following: 2. Duties In The Event Of Occurrence,Offense,Claim Or Suit: a. You must see to it that we are notified of an "occurrence" or an offense which may result in a claim as soon as practicable after the"occurrence" has been reported to you, one of your officers or an"employee"designated to give notice to us. Notice should include: (1) How,when and where the"occurrence"or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or"suit' is brought against any insured, you must: (1) Record the specifics of the claim or"suit"and the date received as soon as you, one of your officers, or an "employee" designated to record such information is notified of it; and (2) Notify us in writing as soon as practicable after you, one of your officers, your legal department or an "employee" you designate to give us such notice learns of the claims or"suit." Item 2.e. is added to SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS: 2.e. If you report an "occurrence" to your workers compensation insurer which develops into a liability claim for which coverage is provided by the Coverage Form, failure to report such "occurrence" to us at the time of "occurrence" shall not be deemed in violation of paragraphs 2.a., 2.b., and 2.c. However, you shall give written notice of this"occurrence"to us as soon as you are made aware of the fact that this "occurrence" may be a liability claim rather than a workers compensation claim. GL-3084 (10119) T4- K. AUTOMATIC ADDITIONAL INSUREDS-EQUIPMENT LEASES SECTION it - WHO IS AN INSURED is amended to include any person or organization with whom you agree in a written equipment lease or rental agreement to name as an additional insured with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, at least in part, by your maintenance, operation, or use by you of the equipment leased to you by such person or organization, subject to the following additional exclusions. The insurance provided to the additional insured does not apply to: 1. "Bodily injury" or"property damage"occurring after you cease leasing the equipment. 2. "Bodily injury" or"property damage"arising out of the sole negligence of the additional insured. 3. "Property damage"to: a. Property owned, used or occupied by or rented to the additional insured; or b. Property in the care, custody or control of the additional insured or over which the additional insured is for any purpose exercising physical control. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. L. INSURED CONTRACT EXTENSION - RAILROAD PROPERTY AND CONSTRUCTION CONTRACTS Item 9. of SECTION V- DEFINITIONS is deleted and replaced with the following. 9. 'Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an"insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. GL-3084 (10/19) -5- Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. M. TURNKEY JOBS -COVERAGE FOR ALIENATED PREMISES It is agreed that: Exclusion 2.j.(2) of SECTION I, COVERAGE A, does not apply if the premises are "your work" and were not occupied, rented or held for rental by you for more than 12 months after completion. N. CONSTRUCTION PROJECT GENERAL AGGREGATE(LIMITS This modifies SECTION III -LIMITS OF INSURANCE. A. For all sums which can be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an "occurrence" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION 1 -COVERAGE C: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard," and for medical expenses under COVERAGE C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits." 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. GL-3084 (10/19) -6- B. For all sums which cannot be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an "occurrence" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION I -COVERAGE C: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C. Payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If a construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of SECTION III - LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to be applicable. O. FELLOW EMPLOYEE COVERAGE Exclusion 2.e. Employers Liability of SECTION I, COVERAGE A, is deleted and replaced with the following: 2.e. "Bodily injury"to (1) An "employee"of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of paragraph (1)above. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to: (1) Liability assumed by the insured under an"insured contract"; or (2) Liability arising from any action or omission of a co-"employee" while that co-"employee" is either in the course of his or her employment or performing duties related to the conduct of your business. GL-3084 (10/19) -7- With respect to "bodily injury", "property damage", or 'personal and advertising injury" arising out of your ongoing operations; or operations included within the "products-completed operations hazard", the policy to which this coverage is attached shall apply as excess insurance over coverage available to "you" under a Consolidated Insurance Program (such as an Owner Controlled Insurance Program or Contractors Controlled Insurance Program). Coverage afforded by this endorsement does not apply to any Consolidated Insurance Program involving a "residential project" or any deductible or insured retention, specified in the Consolidated Insurance Program. The following is added to Section V—Definitions: "Residential project" means any project where 30% or more of the total square foot area of the structures on the project is used or is intended to be used for human residency. This includes but is not limited to single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments and appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). A "residential project" does not include military owned housing, college/university owned housing or dormitories, long term care facilities, hotels, motels, hospitals or prisons. All other terms, provisions, exclusions and limitations of this policy apply. V. AUTOMATIC ADDITIONAL INSUREDS-MANAGERS OR LESSORS OF PREMISES SECTION II—WHO IS AN INSURED is amended to include: Any person or organization with whom you agree in a written contract or written agreement to name as an additional insured but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises, designated in the written contract or written agreement, that is leased to you and subject to the following additional exclusions; This insurance does not apply to: 1. Any"occurrence"which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured listed in the written contract or written agreement. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. W. AUTOMATIC ADDITIONAL INSUREDS - STATE OR GOVERNMENTAL AGENCY OR POLITTCAL SUBDIVISIONS—PERMITS OR AUTHORIZATIONS SECTION II — WHO IS AN INSURED is amended to include any state or governmental agency or subdivision or political subdivision with whom you are required by written contract, ordinance, law or building code to name as an additional insured subject to the following provisions: This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. This insurance does not apply to: GL-3084 (10119) -14- a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or"property damage" included within the "products-completed operations hazard This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. X. CONTRACTORS AUTOMATIC ADDITIONAL INSGREO COVERAGE—COMPLETED OPERATIIONS SECTION II WHO IS AN INSURED is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy for completed operations, but only with respect to liability for"bodily injury" or"property damage" caused, in whole or in part, by "your work" at the project designated in the contract, performed for that additional insured and included in the"products-completed operations hazard". This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. Y. ADDITIONAL INSURED —ENGINEERS, ARCHITECTS OR SURVEYORS SECTION II -- WHO IS AN INSURED is amended to include as an additional insured any architect, engineer or surveyor who is required by written contract to be an additional insured on your policy, 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 performed by you or on your behalf. This includes such architect, engineer or surveyor, who may not be engaged by you, but is contractually required to be added as an additional insured to your policy. 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 the failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or 2. Supervisory, inspection or engineering services. GL-3084 (10/19) -15- This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-3084 (10/19) -16- 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule, (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain.this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2%of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 06/30/2024 Policy No. 7600023383241 Endorsement No. 001 Insured: A.J. Fistes Corporation Premium$INCL. Insurance Company:Everest Premier Insurance Company Countersigned By: -1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual-I999. i