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BNS CONSTRUCTION (OCFA FIRE STATION #70 REMODEL, ADA RESTROOM AND GENERATOR UPGRADE)
!NSURANCL:U,u HH' 1NORK MAY PROCEED UNTIL INS URA Cf EXL'IRt, -�- -------- CITY OF SANTA ANA JT' CLERK CONSTRUCTION CONTRACT AGREEMENT �A'L MAY 3 0 201.E PROJECT NO.: 24-6626 OCFA FIRE STATION 470 REMODEL, ADA RESTROOM AND GENERATOR UPGRADE This CONSTRUCTION CONTRACT is made and entered into this Ist day of April, 2025 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 BNS Construction (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 OCFA Fire Station#70 Remodel,ADA Restroom and Generator Upgrade Project (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 Five Hundred Seventy-Three Thousand Dollars and No Cents ($573,000.00), 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. rev.09/01/2017 Page 1 of 4 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, but 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 WORD. 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 CWA. The CWA may be found on the City's website at: https://vvww.santa-ana.org/documents/community-workforce-agreement/ 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 2 of 4 (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. [signature page to follow] i Page 3 of 4 IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: CITY OF SANTA ANA 1 IFE A ��• Minh Thai City Cler Assistant City Manager APPROVED AS TO FORM: SONIA R. CARVALHO CONTRACTOR: City Attorney BNS Construction KYjE NELLESEN NAME: Ron Shashua Assistant City Attorney TITLE: Owner RECOMMENDED FOR APPROVAL: Digitally signed by Nal Saba N a b i l Saba Date:2025.03.17 11:40:23-07'00' NABIL SABA, PE Executive Director Public Works Agency Page 4 of 4 Exhibit A CITY OF SAN'TA ANA. - PROPOSAL PROJECT NO,: 23-6626 OCFA FIRE STATION#70 REMODEL, ADA RESTROOM AND GENERATOR UPGRADE BID PROPOSAL TO: CITY COUNCIL,OF THE CITY OF SANTA ANA FROM: BNS Construction 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 j plans (if any) and the specifications for the unit price(s)or lump sum(s) set forth in,the following 1 schedule: i Item Description Qty Unit Unit Price Amount 1 Fire Station 70 Tenant Improvements 1 LS $557,978.00 $ 557,978.00 2 Project Advertisement Sign 1 EA $2,000 $ 2,000.00 3 As-builts I LS $5,000 $ 5,000.00 4 Construction Perna t 1 LS $8,022 $ 8,022.00 TOTAL BASE BID $ 573,000.00 The lowest.responsible bidder shall be selected based on the total base bid. 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 tho"25%"limit as stated in Section 7-3.5 of the Standard Specifications. The actual amount for 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. t This bid item is considered a Specialty Item per Section 3-2 of the Standard Specifications. 3 i TIME FOR COMPLETION OF IMPROVEMENTS AND LIQUIDATED DAMAGES a The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, within number (150) working dam after the commencement date stated in the Notice to � ;i 71 5 1 P-1 of P-18 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 23-6626 OCFA FIRE STATION 470 REMODEL,ADA RESTROOM AND GENERATOR UPGRADE Proceed. Upon issuance of the Notice to Proceed, Contractor shall immediately place order for long-lead time items. The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $3,600 per calendar day. Name of Firm BNS Construction Signature of BIDDER Title Owner (If an individual, 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-18 Act O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMroorYYYY) 05/07/2026 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 Daryl Zam 11 Bravo Insurance Services NAME: ry 23705 Vanawen St.#307 P"CNo Ext: (818)351-5777 � No; (818)351-5778 West Hills, CA 91307 E-MAIL ADDRESS: Daryl@11bravoins,com License#: OM79887 INSURERS AFFORDING COVERAGE NAIC If INSURER A: Gotham Insurance Company INSURED N S S CONSTRUCTION INSURER B: Pro ressive West Ins Co DBA: B RON S INSURER C: Nautilius Insurance Co 18440 HATTERAS ST 33 INSURER : Evanston Insurance Company Tarzana, CA 91356 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 00001342-250402183753 REVISION NUMBER: 7 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 REQUIREMLNT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 EFF POLICY EXP LTR POLICY NUMBER MMlDD1YYYY MMOWYYYY LIMITS A x COMMERCIAL GENERAL LIABILITY Y Y GL202500028129 01107/2026 01107/2026 EACH OCCURRENCE $ 1,000 000 DAMAGE TO RETED CLAIMS-MADE �OCCUR PREMISES(Ea oecu r nce) $ 300,000 MED EXP(Anyone person) $ 5,0()() PERSONAL&AOV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY ECT ❑LOG PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y 993140787 02/1412026 02/1412026 EOa eoodeDISINGLE LIMIT $ 1 000 000 X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accldenl) $ X X HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA u B OCCUR AN1346546 04/28/2025 01107/2026 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 10,000,000 DED RETENTION$ S WORKERS COMPENSATION IPER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE I I ER ANY PROPRIETORIPARTNERIEXECUTNE OFFICERYMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory In NHI E.L.DISEASE-EA EMPLOYE $ If yes,describe under _ I DESCRIPTION OF OPERATIONS helow E.L.DISEASE-POLICY LIMIT $ D Pollution Liability CPLMOL131126 04/28/2025 04/2812026 Per claim/Aggregate $1 M!$2M DESCRIPTION OF OPERATIONS I LOCATION$I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Commercial umbrella for$5,000,000 per occurrence and$10,000,000 aggregate is over the commercial general liability(CGL) and the commercial auto liability (AL). Making the CGL$6,000,000 per occurrence and $11,000,000 aggregate and making the AL:$6,000,000 combined single limit. City of Santa Ana, its City Council, officers,officials,employees, agents,and volunteers are to be covered as additional insureds on Contractor's CGL and AL policies with respect to liability arising out of work operations performed by or on behalf of Contractor including materials, parts,and equipment furnished in connection with such work or operations and automobiles owned, leased, hired, or borrowed by or on behalf of Contractor.Additional insured continued on ACORD 101 Additional Remarks Schedule CERTIFICATE HOLDER APPROVED ICANCELLATION By Tu Tran Nguyen at 8.22 am,May 12,2025 I 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. 20 Civic Center Plaza T D'egitally signed Santa Ana, CA 92701 Tu 1 ran by Tu Tran Nguyen AUTHORIZED REPRESENTATIVE Nguyen Date:2025.05 12 7 08:26:40-07'00' DSZ Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by DSZ on 05/07/2025 at 03:05PM AGENCY CUSTOMER ID: _ LOC#; AC" ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED 11 Bravo Insurance Services RON SHASHUA PBLICYNUM6ER bBA: B N S CONSTRUCTION NIA CARRIER NAIC COPE Multiple Carriers EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: .Certificate of Liability Insurance (continued from Description of Operations) status can be provided in the form of an endorsement to Contractor's insurance. ACORD 101 (2008101) d 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by DSZ on May 07,2025 at 03:05PM Ac© CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDIYYYY) 05/06/2025 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 NONTACT AME; Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. Lrc0NN Ext: 1-800-524-7024 Fu C No E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC# Roseland NJ 07068 INSURER A: State Compensator Insurance Fund 35076 INSURED BNS Construction INSURER B: INSURER C: 18633 Topharn St Apt 222 INSURER D: INSURER E: Tarzana CA 91335 INSURER F: COVERAGES CERTIFICATE NUMBER: 4296255 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 EFF POLICY EXP LTR INSD WVD POLICY NUMBER. MMIDDfYYYY) (MWDDffYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) S PERSONAL&ADV INJURY 5 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 POLICY a JECT PRO ❑ LOC PRODUCTS-COMPIOP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea amidenl ANY AUTO BODILY INJURY(Per person) 5 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Par accident) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR F1 CLAIMS-MADE AGGREGATE $ DIED I I RETENTION 5 $ WORKERS COMPENSATION PEER EMPLOYERS'LIABILITY YIN 1 STATUTE ER ANY PROPRIETOWPARTNEPJEXECUTIVE E.L.EACH ACCIDENT A OFFICEWMEMBEREXCLUDED? �Y NSA Y 9259633-2024 08123J2024 08/2312025 (Mandatory in NH) E.L.DISEASE-FAEfVIPLOYEE 5 4,000,000 If yes,describe Lnder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 1.,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161,Additional Remarks Schedule,may be attached if more space is required) This certificate has a blanket Waiver of Subrogation for the following states):CA Job Locations: ,CA APPROVED By Tu Tran Nguyen at 8:23 am,May 12,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Public Works Agency ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 �tm _W) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION BLANKET BASIS 9259633-24 FUND RENEWAL SC. HOME OFFICE 0-45-93-71 SAN FRANCISCO EFFECTIVE AUGUST 23, 2024 AT 12. 01 A.M. PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AND EXPIRING AUGUST 23, 2025 AT 12. 01 A.M. AT 72:01 AM PACIFIC STANDARD? TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME HNS CONSTRUCTION 18440 HATTERAS ST APT 33 TARZANA, CA 91356 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US, THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAND INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 26, 2024 2572 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (RFV.4-2018) OLD DP 217 ENDORSEMENT AGREEMENT 9259633-24 RENEWAL FUND Sc HOME OFFICE SAN FRANCISCO EFFECTIVE AUGUST 23, 2024 AT 12 . 01. A.M. PAGE 1 OF 2 ALL EFFECTIVE DATES ARE AND EXPIRING AUGUST 23, 2025 AT 12 .01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME BNS CONSTRUCTION 18440 HATTERAS ST APT 33 TARZANA, CA 91356 ANY CONTRADICTION BETWEEN THE POLICY AND THIS ENDORSEMENT WILL BE CONTROLLED BY THIS ENDORSEMENT. IT IS AGREED THAT THE FOLLOWING CLASSIFICATION(S) IS (ARE) HEREBY ADDED TO AND MADE A PART OF THIS POLICY. RATE(S) EFFECTIVE UP TO 8/23/25 - INTERIM STANDARD BASE BILLING CLASS DESCRIPTION OF WORK RATE* RATE* 5432-1 CARPENTRY-.,INCLUDING THE INSTALLATION 17.29 17.72 OF INTERIOR TRIM, DOORS AND CABINET WORK IN CONNECTION THEREWITH--EMPLOYEES WHOSE REGULAR HOURLY WAGE EQUALS OR EXCEEDS $39.00 PER HOUR--N.O.C. ASSIGNMENT OF THIS .CLASSIFICATION IS SUBJECT TO VERIFICATION AT THE TIME OF FINAL AUDIT THAT THE EMPLOYEE'S REGULAR HOURLY WAGE EQUALS OR EXCEEDS $39.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $39.00 PER HOUR SHALL BE CLASSIFIED AS 5403(1) , "CARPENTRY." *THE BASE RATE IS PROVIDED FOR YOUR INFORMATION. IT IS THE RATE WHICH STATE COMPENSATION INSURANCE FUND HAS FILED WITH THE DEPARTMENT OF INSURANCE. THE INTERIM BILLING RATE WILL BE USED ON PAYROLL REPORTS. IT TAKES INTO ACCOUNT RATING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL BILLING. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 26, 2024 9961 AUTHpRIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 MEVA-20181 OLD OP 217 ENDORSEMENT AGREEMENT STATE 9259633-24 RENEWAL FUND SC HOME OFFICE SAN FRANCISCO EFFECTIVE AUGUST 23, 2024 AT 12 .01 A.M. PAGE 2 OF 2 ALL EFFECTIVE DATES ARE AND EXPIRING AUGUST 23, 2025 AT 12 .01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME BNS CONSTRUCTION 18440 HATTERAS ST APT 33 TARZANA, CA 91356 CONTINUED INTERIM STANDARD BASE BILLING CLASS DESCRIPTION OF WORK RATE* RATE* 540.3-1 CARPENTRY--INCLUDING THE INSTALLATION 44.16 45.27 OF INTERIOR TRIM, DOORS AND CABINET WORK IN CONNECTION THEREWITH--EMPLOYEES WHOSE REGULAR HOURLY WAGE DOES NOT EQUAL OR EXCEED $39.00 PER HOUR--N.O.C. IF THIS CLASSIFICATION CHANGE RESULTS IN INCREASED POLICY PREMIUM, YOU ARE ENTITLED, AS PROVIDED BY INSURANCE CODE SECTION 11753.1, TO REQUEST THAT THE CLASSIFICATION DECISION BE RECONSIDERED BY THE STATE COMPENSATION INSURANCE FUND. PLEASE CONTACT YOUR LOCAL DISTRICT OFFICE. *THE BASE RATE IS PROVIDED FOR YOUR INFORMATION. IT IS THE RATE WHICH STATE COMPENSATION INSURANCE FUND HAS FILED WITH THE DEPARTMENT OF INSURANCE. THE INTERIM BILLING RATE WILL BE USED ON PAYROLL REPORTS. IT TAKES INTO ACCOUNT RATING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL BILLING. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRRANCISCO: AUGUST 26, 2024 9961 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 MEV.4-20181 OLD DP 217 AL£X W KOUTSOUBAS pR99RAg0111A ® 9036 RESEDA BLVD#105 COWNERC= NORTHRIDGE,CA 91324 Policy number: 993140787 Underwritten by: United Financial Cas Cc Insured: Ron Shashua Ron 5hashua 18440 HATTERAS ST LOS ANGELES,CA 91356 May 8,2025 Policy Period:Feb 14,2025-Aug 14,2025 Mailing Address United Financial Cas Cc PO Box 94739 Additional insured endorsement Cleveland,CH44101 1-800-444-4487 Name of Person or Organization For customer service,24 hours a day, CITY OF SANTA ANA ITS CITY COUNCIL, OFFICERS, EMPLOYEES,AGE 7 days a week 20 CIVIC CENTER PLAZA SANTA ANA, CA 92071 This endorsement modifies insurance provided under the commercial auto policy and any endorsements thereto affording liability coverage. The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page and showing liability coverage. Limit of Liability Bodily Injury Not applicable Property Damage Not applicable Combined Liability $100,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number:993140787 Issued to(Name of Insured):Ron 5hashua Effective date of endorsement:May 7, 2025 Policy expiration date:August 14, 2025 Form 1 198 0711 6) ALEX W KOUTSOUBAS pl70L RFINY 9036 RESEDA BLVD#105 COMMERCIAL NORTHRIDGE,CA 91324 Policy number: 993140787 Underwritten by: United Financial Cas Co Insured; Ron Shashua Ran Shashua 18440 HATTERAS ST May 8,2025 LOS ANGELES,CA 91356 Policy Period:Feb 14,2025-Aug 14,2025 Mailing Address United Financial Cas Co PO Box 94739 Cleveland,Oh 44101 1-800-444-4487 For customer service,24 hours a day, 7 days a week Waiver of Subrogation Endorsement This endorsement modifies insurance provided under the following: Commercial Auto Policy Motor Truck Cargo Liability Coverage Endorsement Commercial General Liability Coverage Endorsement We agree to waive any and all subrogation claims against the person or organization designated below. Name of Person or Organization: CITY OF SANTA ANA ITS CITY COUNCIL,OFFICERS, EMPLOYEES,AGE 20 CIVIC CENTER PLAZA SANTA ANA,CA 92071 This endorsement applies to policy number: 993140187 Issued to: Ron Shashua Endorsement effective: May 7,2025 Expiration: August 14,2025 All other terms, limits and provisions of this policy remain unchanged. Form 8610(02119) Palomar COMMERCIAL INLAND MARINE DECLARATIONS INSURING AGREEMENT Named Insured and Mailing Address: Ron Shashua-BNS Construction 18440 Hatteras St#33 Tarzana, CA 91356 Producer No.: PSIC-27-18 Policy Number: CPBRP-25-1249522-00 S.Philips Surety&Insurance Services,Inc Effective Date: 06/01/2025-05/31/2026 Ester Sadusky Issued by the insurance companies indicated below, herein called the Company: PALOMAR SPECIALTY INSURANCE COMPANY Policy Period Insurance is issued by the Company in consideration of payment of the required premium. This policy is issued for the period 12:01 AM standard time at the Named Insured's mailing address shown above: From: 06/01/2025 To: 05/31/2026 This Insuring Agreement together with the Premium Summary, Forms and Endorsements List, Declarations, Policy Forms, and Endorsements comprise this policy. Insurance is provided at those locations and for those coverages and Limits of Insurance shown in the Declarations and most recent Statement of Values. Endorsements may contain separate deductibles and limits or sub-limits of insurance. Certain words and phrases in this policy have specific meaning. The meaning of such words and phrases are found in the Definitions. Definitions that apply to individual forms or endorsements will be noted in those forms and endorsements. These definitions apply to the entire policy and any endorsements to it. Titles of the various paragraphs of this policy and of endorsements attached to the policy are inserted solely for convenience or reference and shall not be deemed in any way to limit or affect provisions to which they relate. You are presumed to have actually read this policy and understood its terms, whether this is the first policy year or a renewal of a prior policy. Please review the entire policy immediately and contact us or your agent or broker with any questions you may have. PLMR DEC-BR V20 4 - Page 11 Palomar PREMIUM SUMMARY Premium Payment The first Named Insured shown in the declarations is responsible for the payment of all premiums and will be the payee for any return premiums we pay. COMMERCIAL INLAND MARINE COVERAGE PREMIUM Builders Risk Policy Premium $1,516.54 Terrorism INCLUDED Total Premium $1,516.54 Inspection Fee None Policy Fee None Total Premium and Fees $1,516.54 PLMR DEC-BR V20 4 Page 12 y� Palomar FORMS AND ENDORSEMENTS Named lnsured: Ron Shashua - BNS Construction Policy Number: CPBRP-25-1249522-00 Effective Date: 06/01/2025 The following policy forms and endorsements have been attached to and made a part of the policy. FORM NAME FORM NUMBER COMMERCIAL INLAND MARINE AND BUILDERS RISK DECLARATIONS PLMR DEC-BR 04 20 COMMERCIAL INLAND MARINE CONDITIONS CM 00 01 09 04 COMMON POLICY CONDITIONS IL 00 01 01 07 BUILDERS RISK COVERAGE FORM PLMR BR 0001 03 20 NON-RENEWAL ENDORSEMENT PLMR BR 0010 04 20 CALIFORNIA CHANGES IL 01 04 09 07 CALIFORNIA CHANGES-ACTUAL CASH VALUE IL 01 02 02 20 CALIFORNIA CHANGES -CANCELLATION AND NONRENEWAL IL 02 70 12 19 EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES IL 09 35 07 02 DISCLOSURE PURSUANT TO TERRORISM INSURANCE ACT IL 09 85 12 20 CAP ON LOSSES FROM TERRORISM IL 09 52 01 15 IM SIGNATURE PAGE SIG 04 20 IM OFAC OFAC 04 20 IM CLAIMS IM-CLAIMS 08 22 PLMR DEC-BR V20_4 Page 3 Palomar BUILDERS RISK OVERAGE FORM DECLARATIONS A. LIMITS OF INSURANCE L COVERAGE AND LIMITS OF INSURANCE: Coverage is provided only if a Limit of Insurance is shown. The most we will pay for a "loss" is: Limit of Insurance, any one "loss" occurrence: $ 530,000 Unless stated otherwise in the policy, in no event will our liability exceed this limit for any one "loss" occurrence, regardless of the number of coverages, causes of loss or locations involved, and regardless of any additional coverages provided under this policy Limit of Insurance, as respects Covered Property at the project site: $ 530„000 Limit of Insurance, as respects "Useable Existing Structure" Not Covered Limit of Insurance, as respects Covered Property at any other location, other than in due course of transit: $ 100,000 Limit of Insurance, Covered Property in due course of transit: $ 100,000 Limit of Insurance, on the job-site trailer limit: $40,000 Limit of insurance, on the job-site trailer contents $20,000 2. ADDITIONAL COVERAGE: Coverage is provided only if a Limit of Insurance is shown. The most we will pay for "loss" is: Debris Removal: 25% Additional Debris Removal $25,000 Pollutant Clean-Up and Removal: $25,000 Fire Department Service Charge: $ 15,000 Plans & Records: $25,000 Contract Penalty: $ 15,000 Expediting and Extra Expenses: $25,000 Inventory,Appraisals and Loss Adjustment Expenses $ 7,500 Fire Protection Devices: $25,000 Escalation Expense: $ 100,000 Sewer and Drain Back Up: $ 10,000 "Fungus" Limited Coverage $25,000 3, OPTIONAL COVERAGES: Coverage is provided only if a Limit of Insurance is shown. Soft Costs $ 50,000 Rental Income Not Covered Ordinance or Law-"Loss"to the Undamaged Portion: Not Covered Ordinance or Law-Demolition and ICC Not Covered PLMR DEC-BR V24_4 Page 14 a Palomar B DESCRIPTION OF PROJECT Renovation EXCLUDING existing structure to fire station 2500 sq ft- I story-Frame C LOCATION OF PROJECT SITE (Address) 2301 Old Grand St Santa Ana, CA 92705 D DEDUCTIBLES All Other Perils-$5,000 E MORTGAGE HOLDERS/LOSS PAYEES F SPECIAL PROVISIONS. IF ANY PLMR DEC-BR V20_4 Page 5 Palomar PLMR BR 0001 BUILDERS RISK COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and what is not covered. Throughout this policy the words "you"and "your" refer to the Named Insured shown in the Declarations.The words "we," "us" and 'bur" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section F.- DEFINITIONS in this Coverage Form. We will pay for"loss"to Covered Property from any of the Covered Causes of Loss. I COVERED PROPERTY Covered property means your property or the property of others for which you are liable, consisting of: Buildings or structures as described in this Coverage Form Declarations while under construction, erection, or fabrication, including the costs of foundations and underground property such as pipes, flues, drains, electrical wires, piers, and pilings; and excavation, grading, and filling; if such costs are included in the completed value of the project. Materials, supplies, furniture and appliances, machinery, equipment and fixtures which will become a permanent part of the buildings or structures at the project site described in this Coverage Form Declarations. Temporary buildings or structures at the project site described in this Coverage Form Declarations. Scaffolding, construction forms, fences, and office trailers at the project site described in this Coverage Form Declarations if such values are included in the completed value of the project; and Temporary enclosure materials and associated installation labor if such values are included in the completed value of the project. t "Useable Existing Structures)", but only when a Limit of Insurance appears in the Policy Declarations. 2. PROPERTY NOT COVERED Covered Property does not include: Machinery, tools, equipment, and other property not intended to become a permanent part of the project, except as specified in A.1. above; Trees, shrubs, sod, and plants. But we do cover such property at the project site for "loss" caused by or resulting from fire, lightning, explosion, civil disturbance, riot, vehicles, aircraft, theft or vandalism if such values are included in the completed value of the project. Property while waterborne except on regularly scheduled ferries; Contraband or property in the course of illegal transportation or trade; Land (including land on which the property is located) or water: Accounts, bills, currency, deeds, evidences of debt, money, notes or securities; or Buildings or Structures that exist prior to any alteration, addition, improvement, renovation or repair, unless a limit for"Useable Existing Structure(s)" is shown in the Declarations as described in A.1.f. above. PLMR BR 0001 V20_03 Palomar PLMRBRo0q, 3. COVERED CAUSES OF LOSS Covered Causes of Loss means RISKS OF DIRECT PHYSICAL "LOSS" to Covered Property except those causes of"loss" listed in the Exclusions. 4. WHEN COVERAGE APPLIES a. Coverage applies while Covered Property is: i At the construction jobsite awaiting, during and after construction, erection or fabrication; ii. At any "temporary" location other than the project site;or iii In transit. I� Coverage ends when one of the following occurs: The owner or purchaser accepts the property; 0 Your interest ceases; iii. You abandon the construction with no intention to complete it; iv When a structure is occupied or put to its intended use,without our written consent; Any other insurance covers the property as a completed building or structure; or vi. This policy expires or is cancelled. 5. ADDITIONAL.COVERAGES Additional Coverage Limits of Insurance are separate from the Limits of Insurance shown in Section 1. of the Declarations. As a result of direct physical "loss" to Covered Property from a Covered Cause of Loss, we will pay up to the Limit of Insurance shown in Section 2.of the Declarations for the following: Debris Removal i. We will pay your expenses to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical "loss." The most we will pay under this Additional Coverage is the percentage shown on the Declarations which is the sum of the amount we pay for direct physical "loss" to Covered Property plus the applicable deductible amount, but not more than the amount shown in section 1. of the Declarations. This Additional Coverage does not apply to costs to: a) Extract"pollutants"from land or water; or I)? Remove, restore or replace polluted land or water. 1) Additional Debris Removal If the sum of debris removal expense, deductible amount and our payment for direct physical "loss" exceeds the applicable Limit of Insurance in Section 1. of the Declarations, we will pay up to the Limit of Insurance shown in the Declarations for Additional Debris Removal Expense. Pollutant Clean-Up and Removal We will pay your expenses to extract"pollutants"from land or water at the job site if the discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the Covered Cause of Loss occurs. This Additional Coverage does not apply to costs to test for, monitor or assess the existence, concentration or effects of"pollutants." But we will pay for testing which is performed in the course of extracting the PLMR BR 0001 V20_03 IL02701219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation 3. All Policies In Effect For More Than 60 Days Common Policy Condition are replaced by the a. If this policy has been in effect for more following: than 60 days, or is a renewal of a policy we 2. All Policies In Effect For 60 Days Or Less issued, we may cancel this policy only upon If this policy has been in effect for 60 days or the occurrence, after the effective date of less, and is not a renewal of a policy we have the policy,of one or more of the following: previously issued,we may cancel this policy by (1) Nonpayment of premium, including mailing or delivering to the first Named payment due on a prior policy we Insured, at the mailing address shown in the issued and due during the current policy, and to the producer of record, advance policy term covering the same risks. written notice of cancellation, stating the (2) Discovery of fraud or material reason for cancellation, at least: misrepresentation by: a. 10 days before the effective date of (a) Any insured or his or her cancellation if we cancel for: representative in obtaining this (1) Nonpayment of premium;or insurance; or (2) Discovery of fraud by: (b) You or your representative in (a) Any insured or his or her pursuing a claim under this policy. representative in obtaining this (3) A judgment by a court or an insurance; or administrative tribunal that you have (b) You or your representative in violated a California or Federal law, pursuing a claim under this policy. having as one of its necessary elements b. 30 days before the effective date of an act which materially increases any of cancellation if we cancel for any other the risks insured against. reason. IL 02 70 12 19 ©Insurance Services Office, Inc., 2019 Page 1 of 4 i i (4) Discovery of willful or grossly negligent B. The following provision is added to the acts or omissions, or of any violations of Cancellation Common Policy Condition: state laws or regulations establishing 7. Residential Property safety standards, by you or your representative, which materially This provision applies to coverage on real increase any of the risks insured property which is used predominantly for against, residential purposes and consisting of not (5) Failure by you or your representative to more than four dwelling units, and to coverage implement reasonable Inns control on tenants household personal property in a residential unit, if such coverage is written requirements, agreed to by you as a under one of the following: condition of policy issuance, or which were conditions precedent to our use of Commercial Property Coverage Part Farm a particular rate or rating plan, if that Coverage Part - Farm Property - Farm failure materially increases any of the Dwellings, Appurtenant Structures And risks insured against. Household Persona! Property Coverage Form (6) A determination by the Commissioner a. If such coverage has been in effect for 60 of Insurance that the: days or less, and is not a renewal of coverage we previously issued, we may (a) Loss of, or changes in, our cancel this coverage for any reason, except reinsurance covering all or part of as provided in b. and c.below. the risk would threaten our financial b. We may not cancel this policy solely integrity or solvency; or because the first Named Insured has: (b) Continuation of the policy coverage (1) Accepted an offer of earthquake would: (i) Place us in violation of California coverage;or law or the laws of the state (2) Cancelled or did not renew a policy where we are domiciled; or issued by the California Earthquake Authority (CEA) that included an (ii) Threaten our solvency. earthquake policy premium surcharge. (7) A change by you or your representative However, we shall cancel this policy if the in the activities or property of the first Named Insured has accepted a new or commercial or industrial enterprise, renewal policy issued by the CEA that which results in a materially added, includes an earthquake policy premium increased or changed risk, unless the surcharge but fails to pay the earthquake added, increased or changed risk is policy premium surcharge authorized by included in the policy. the CEA. b. We will mail or deliver advance written c. We may not cancel such coverage solely notice of cancellation, stating the reason for because corrosive soil conditions exist on cancellation, to the first Named Insured, at the premises. This restriction (c.) applies the mailing address shown in the policy, only if coverage is subject to one of the and to the producer of record, at least: following, which exclude lass or damage (1) 10 days before the effective date of caused by or resulting from corrosive soil cancellation if we cancel for conditions: nonpayment of premium or discovery of (1) Commercial Property Coverage Part - fraud; or Causes Of Loss-Special Form;or (2) 30 days before the effective date of (2) Farm Coverage Part - Causes Of Loss cancellation if we cancel for any other Form - Farm Property, Paragraph D. reason listed in Paragraph 3.a. Covered Causes Of Loss-Special. Page 2 of 4 O Insurance Services Office, Inc., 2019 IL 02 7012 19 d. if a state of emergency under California b. We will not refuse to renew such coverage Law is declared and the residential property solely because the first Named Insured has is located in any ZIP Code within or accepted an offer of earthquake coverage. adjacent to the fire perimeter, as However, the Following applies only to determined by California Law, we may not insurers who are associate participating cancel this policy for one year, beginning insurers as established by Cal. Ins. Code from the date the state of emergency is Section 10089.16. We may elect not to declared, solely because the dwelling or renew such coverage after the first Named other structure is located in an area in Insured has accepted an offer of which a wildfire has occurred.However, we earthquake coverage, if one or more of the may cancel: following reasons applies: (1) When you have not paid the premium, (1) The nonrenewal is based on sound at any time by letting you know at least underwriting principles that relate to the 10 days before the date cancellation coverages provided by this policy and takes effect; that are consistent with the approved (2) If willful or grossly negligent acts or rating plan and related documents filed omissions by the Named Insured, or his with the Department of Insurance as or her representatives, are discovered required by existing law; that materially increase any of the risks (2) The Commissioner of Insurance finds insured against;or that the exposure to potential losses will (3) If there are physical changes in the threaten our solvency or place us in a property insured against, beyond the hazardous condition. A hazardous catastrophe-damaged condition of the condition includes, but is not limited to, structures and surface landscape, a condition in which we make claims which result in the property becoming payments for losses resulting from an uninsurable. earthquake that occurred within the C. The following is added and supersedes any preceding two years and that required a provisions to the contrary: reduction in policyholder surplus of at Nonrenewal least 25% for payment of those claims; or 1. Subject to the provisions of Paragraphs C.2. and C.3.below, if we elect not to renew this (3) We have: policy, we will mail or deliver written notice, (a) Lost or experienced a substantial stating the reason for nonrenewal, to the first reduction in the availability or scope Named Insured shown in the Declarations, and of reinsurance coverage;or to the producer of record, at least 60 days, but (b) Experienced a substantial increase not more than 120 days, before the expiration in the premium charged for or anniversary date. reinsurance coverage of our We will mail or deliver our notice to the first residential property insurance Named Insured, and to the producer of record, policies; and at the mailing address shown in the policy. the Commissioner has approved a plan 2. Residential Property for the nonrenewals that is fair and This provision applies to coverage on real equitable, and that is responsive to the changes in our reinsurance position. property used predominantly for residential purposes and consisting of not more than four c. We will not refuse to renew such coverage dwelling units, and to coverage on tenants' solely because the first Named Insured has household property contained in a residential cancelled or did not renew a policy, issued unit, if such coverage is written under one of by the California Earthquake Authority, that the following: included an earthquake policy premium Commercial Property Coverage Part Farm surcharge. Coverage Part — Farm Property — Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. We may elect not to renew such coverage for any reason, except as provided in b., c. and d. below. IL 02 7012 19 O Insurance Services Office, Inc.,2019 Page 3 of 4 d. We will not refuse to renew such coverage 3. We are not required to send notice of solely because corrosive soil conditions nonrenewal in the following situations: exist on the premises, This restriction (d.) a. If the transfer or renewal of a policy,without applies only if coverage is subject to one of any changes in terms, conditions or rates, is the following, which exclude loss or between us and a member of our insurance damage caused by or resulting from group. corrosive soil conditions: b. If the policy has been extended for 90 days (1) Commercial Property Coverage Part - or less, provided that notice has been given Causes Of Loss-Special Form; or in accordance with Paragraph C.1. (2) Farm Coverage Part - Causes Of Loss c. If you have obtained replacement coverage, Form - Farm Property, Paragraph D. or if the first Named Insured has agreed, in Covered Causes Of Loss-Special, writing, within 60 days of the termination of e. If a state of emergency under California the policy,to obtain that coverage. Law is declared and the residential property d. If the policy is for a period of no more than is located in any ZIP Code within or 60 days and you are notified at the time of adjacent to the fire perimeter, as issuance that it will not be renewed. determined by California Law, we may not e. If the first Named Insured requests a nonrenew this policy for one year, change in the terms or conditions or risks beginning from the date the state of covered by the policy within 60 days of the emergency is declared, solely because the end of the policy period, dwelling or other structure is located in an area in which a wildfire has occurred, f. If we have made a written offer to the first However,we may nonrenew: Named Insured, in accordance with the timeframes shown in Paragraph CA., to (1) If willful or grossly negligent acts or renew the policy under changed terms or omissions by the Named Insured, or his conditions or at an increased premium rate, or her representatives, are discovered when the increase exceeds 25%. that materialfy increase any of the risks insured against; (2) If losses unrelated to the postdisaster loss condition of the property have occurred that would collectively render the risk ineligible for renewal; or (3) If there are physical changes In the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. Page 4 of 4 ©Insurance Services Office, Inc., 2019 IL 02 7012 19 Palomar IMPORTANT NOTICE IN WITNESS CLAUSE In return for the payment of premium, and subject to the terms of this policy, coverage is provided as stated in this policy. IN WITNESS WHERE OF,this Company has executed and attested these presents and,where required by law, has caused the policy to be countersigned by its duly Authorized Representative(s). ,�- cpq President Corporate Secretary QUESTIONS REGARDING YOUR INSURANCE? Your agent or broker is best equipped to provide information about your insurance. Should you require additional information or assistance, contact the following (please have your policy or claim number available): Palomar Specialty Insurance Company Customer Service 7979 Ivanhoe Avenue, Suite 500 La Jolla CA 92037 619-567-5290 �c��yiGc�ii l�clri�il Idrspeclalty.Com S#G V20_4 Page 1 COMMERCIAL GENERAL LIABILITY CG 20 01 1219 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 This insurance is primary to and will not seek additional insured. 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 CG 20 0112 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 33 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or "personal added as an additional insured on your policy. and advertising injury" arising out of the Such person or organization is an additional rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury"caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured, engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others by 2. Will not be broader than that which you are that insured, if the "occurrence" which caused required by the contract or agreement to the "bodily injury" or"property damage", or the provide for such additional insured. offense which caused the "personal and A person's or arganiza#ion's status as an advertising injury", involved the rendering of or the failure to render any professional additional insured under this endorsement ends architectural, engineering or surveying when your operations for that additional insured services. are completed. CG 20 33 1219 0 Insurance Services Office, Inc., 2018 Page 1 of 2 2. "Bodily injury" or "property damage" occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to a. All work, including materials, parts or Section III--Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or b. That portion of"your work" out of which the 2, Available under the applicable limits of insurance; injury or damage arises has been put to its intended use by any person or organization whichever is less. other than another contractor or This endorsement shall not increase the subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the same project. Page 2 of 2 0 Insurance Services Office, Inc., 2018 CG 20 33 12 19 COMMERCIAL GENERAL LIABILITY CG 20 39 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT WITH YOU (COMPLETED OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II -- Who Is An Insured is amended to 2. Supervisory, inspection, architectural or include as an additional insured any person or engineering activities. organization for whom you have performed This exclusion applies even if the claims against operations when you and such person or any insured allege negligence or other wrongdoing organization have agreed in writing in a contract or in the supervision, hiring, employment, training or agreement that such person or organization be monitoring of others by that insured, if the added as an additional insured on your policy. "occurrence" which caused the "bodily injury" or Such person or organization is an additional "property damage" involved the rendering of or the insured only with respect to liability for "bodily failure to render any professional architectural, injury"or"property damage"caused, in whole or in part, by "your work" performed for that additional engineering or surveying services. insured and included in the "products-completed C. With respect to the insurance afforded to these operations hazard". additional insureds, the following is added to However, the insurance afforded to such Section III—Limits Of Insurance: additional insured: The most we will pay on behalf of the additional 1. Only applies to the extent permitted by law; insured is the amount of insurance: and 1. Required by the contract or agreement you 2. Will not be broader than that which you are have entered into with the additional insured; required by the contract or agreement to or provide for such additional insured. 2. Available under the applicable limits of B. With respect to the insurance afforded to these insurance; additional insureds, the following additional whichever is less. exclusion applies: This endorsement shall not increase the This insurance does not apply to: applicable limits of insurance. "Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or CG 20 39 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 24 5312 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV--Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. CG 24 5312 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 N7 CITY CLERK PROCESSING FORM Agreements /Amendments / Extensions / Deeds REVIVE FUNDED? COVID FUNDED? CONFIDENTIAL? [] YES 9 NO [I YES A NO 0 YES 9 NO TO: CITY CLERK'S OFFICE FROM: DEPT.: Public Works - Parks, Fleet, Facilities, and Refuse MAIL STOP: M-1 1 - PROJECT MANAGER. Phil Neff/Michelle Cabanas EXT.. 3554 The following imbirmation must be provided in requesting processing of agreements/amendments/extensions/deeds for the C itf. (See page 2 for instructions on how to fill out the this form) NAME OF CONSULTANT I PARTY: BNS Construction K AGREEMENT NUMBER (if applicable): A / N AMENDMENT NUMBER 0 1ST 0 2ND El 3RD El 4TH (if applicable) : EXTENSION NUMBER El 1ST El 2ND I-] 3RD El 4TH (if applicable): An amen dme ntlextensi on requires a copy of a Staff Report and/or initial agreement to be included. AMOUNT: N * OVER El * s5o,o00 *Note: Council approval is required if an agreement with a $50,000 AND UNDER vendor exceeds $50,000 within a Fiscal Year for non- public works agreements. Bid for contracts exceediag-150,000, will continue to requirea formal Invitation for Bid. 1) Approved by council. El 2) NOT approved by council. COUNCIL APPROVAL DATE: 04-01-2025 ITEM#: 17 TERM OF AGREEMENT EFFECTIVE DATE: 04-01-2025 TERMINATION DATE: N/A SIGNATURES REQUIRED: El VENDOR El AGENCY El CITY ATTORNEY H OTHER NOTARIZATION REQUIRED Ll YES 5011 NO APPROVEDINSURANCE: N YES F-1 NO (INSURANCE APPROVAL REQUIRED BY RISK MGMT. PRIOR TO SUBMITTING TO CITY CLERK) COMMENTS: Please contact Marisol for pick-up at x5663 Please send physical copies to Hortencia Martinez M-1 1 _fAAZboo 0(1 me FOR CLERK OFFICE USE ONLY: 0 PROCESS 0 DO NOT PROCESS 0 Missing Signatures 0 Needs Council Approval 0 Other ADDITIONAL REMARKS: c1L t,4 0)"601................ ----------- .................... *Effective July 6, 2023, City Manager contract authority increased via Ordinance NS-3041. 1:IAgreements\Formfform-AGREEMENT PROCESSING FORM-06-19-2023-FINAL.doc Revised:06/1912023 Page 1 of 2