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HomeMy WebLinkAboutPSOMAS (17) A-2023-075-07A MAYOR a. CITY MANAGER Valerie Amezcua ,r'�','�* Alvaro Nunez MAYOR PRO TEM ti 9. s CITY ATTORNEY David Penaloza MAY 11 Sonia R.Carvalho COUNCILMEMBERS o _ CITY CLERK Phil Bacerra Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez Thai Viet Phan Benjamin Vazquez CITY OF SANTA ANA U'Qw+a 1) Oft1t(�z� PUBLIC WORKS AGENCY hhiLln qC-� 20 Civic Center Plaza I PO Box 1988 Santa Ana,California 92702 www.santa-ana.org April 17,2026 PSOMAS. Attn: Robert J. Talafus, Vice President 5 Hutton Centre Drive, Santa Ana, CA 92707 Re: Extension of Agreement No. A-2023-075-07 to provide on-call engineering services Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by PSOMAS and the City of Santa Ana, which commenced on May 2, 2023, the parties hereby exercise their option to extend the term of the Agreement for an additional one (1)year through May 1, 2027. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely o olfo Rosas, P.E. Acting Executive Director, Public Works Agency CITY O SANTA AN ATTEST r _ Alvaro Nunez 1 er L. Hal City Manager City Clerk APPROVED AS TO FORM CONSULTANT 5rfe Nellesen By: Sarah Curran ssistant City Attorney Title:Vice President, Psomas SANTA ANA CITY COUNCIL Valerie Amezcua David Penaloza Thai Viet Phan Benjamin Vazquez Jessie Lopez Phil Bacerra Johnathan Ryan Hernandez Mayor Maypr Prc Tam-Ward 6 and t Ward 2 Ward 3 ward 4 ward 5 yamezWatesanta-ana.om dpenaEOza(Qsanta-ana.orq 1 han santaana or 1)4a�44eTr7k 5anta-ana.ona ICSSI_.e�S�santa-ana.orp bacerra. Santa-ana-p anhamandez Santa-ana.of OR DCERTIFICATE OF LIABILITY INSURANCE rAcATE(MMf a2Y) 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 NAME: Lisa Shimizu-FOokes AssureclPartners Design Professionals Insurance Services, LLC PHONN 714�27-3482 FAX 3697 Mt. Diablo Blvd Suite 230 A1C No: Lafayette CA 94549 E-MAIL CertsDesignPro@AssuredPartners.com INSURER(S)AFFORDING COVERAGE NAIC# License#:6003745 INSURER A:XL Specially Insurance Co. 37885 INSURED PSOMASM1 INSURER B: PSOMAS 865 S. Figueroa Street, Suite 3200 INSURERC: Los Angeles CA 90017 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1191246620 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 POLICYNUMBER MMfDDlYYYY MMfDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence 5 MED EXP(Any one person) 5 PERSONAL&AOV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY❑ PRO ❑ LOC PRODUCTS-COMPIOPAGG $OTHER: $ AUTOMOBILE LIABILITY CoMHINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY{Per accident} $ HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S CEO RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i $ A Professional Liah s Pall,Liah Y ❑PR5048464 10115/2025 10/15/2026 Per Claim $2,000,000 Claims-Made Form Aggregate Llmit $2,000,000 Retro Oates 10/15/1947 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more spate is required( orgi,allY signed Additional Insured Status is not available on Professional Liability Policy. TU Tran by Tu T.. 2SAN051700/01 -Cityof Santa Ana On-Call Agreement A-2023-075-07. Datei2 g N g Uye n Dace:zozs.,,oa Insurance coverage includes waiver of subrogation per the attached endorsement(s). m-J,n9-caoo' APPROVED sy Tu Tran Nguyen at 7:30 am,Nov 04,2025 CERTIFICATE HOLDER CANCELLATION 30 Day Notice ot Uancellation 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. Attn: June VU&Zianya Arroyo 20 Civic Center Plaza M-11 AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 ,r.r. O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD This endorsement, effective 12:01 a.m.,.10/15/2025 forms a part of Policy No. DPR5048464 Issued to PSOMAS by XL Specialty Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF POLICY CANCELLATION—BLANKET NOTICE TO DESIGNATED ENTITIES This endorsement modifies insurance provided under the following: PROFESSIONAL, ENVIRONMENTAL AND NETWORK SECURITY LIABILITY POLICY—ARCHITECTS, CONSULTANTS AND ENGINEERS Section XI.OTHER CONDITIONS, Paragraph A. Cancellation is amended by the addition of the following: In the event thatthe Company cancels or non-renews this Policy during the POLICY PERIOD,the Company agrees to provide thirty (30) days' prior written notice of cancellation or non-renewal of this Policy to any entity with whom the NAMED INSURED agreed in a written contract or agreement would be provided with notice of cancellation or non-renewal of this Policy, provided that: 1. The Company receives, at least thirty(30)days prior to the date of cancellation or non-renewal, a written request from the NAMED INSURED to provide notice of cancellation to entities designated by the NAMED INSURED to receive such notice; and 2. The written request includes the name, address and email of each person or entity designated by the NAMED INSURED to receive such notice. The Company will assume that the list provided to the company by the NAMED INSURED is a complete and accurate list. This endorsement does not apply to non-renewal of the Policy at the end of the POLICY PERIOD or cancellation of the Policy for non-payment of premium to a premium finance company authorized to cancel the Policy. Furthermore, nothing contained in this endorsement shall be construed to provide any rights under the Policy to the entities receiving notice of cancellation pursuant to this endorsement, nor shall this endorsement amend or alter the effective date of cancellation stated in the cancellation notice issued to the NAMED INSURED. All otherterms and conditions of the Policy remain unchanged. LDD 465 0620 Page 1 of 1 ©2020 X.L.America, Inc. All Rights Reserved. May not be copied without permission. Policy# DPR5048464 2. The specific nature and extent of the injury or damage that has been sustained; and 3. How the INSURED first became aware of such CIRCUMSTANCE(S), then any CLAIM(S) that may subsequently be made against the INSURED arising out of such reported CIRCUMSTANCE(S)shall be deemed to have been made on the date first written notice of the CIRCUMSTANCE(S)was received by the Company.This right conferred upon the INSURED in this Paragraph shall terminate at the end of the POLICY PERIOD and shall not exist during the Automatic Extended Reporting Period or Optional Extended Reporting Period. XI. OTHER CONDITIONS A. Cancellation This Policy may be canceled by the NAMED INSURED by surrender thereof to the Company or any of its authorized agents or by mailing to the Company written notice stating when thereafter the cancellation shall be effective. This Policy may be canceled by the Company by mailing to the NAMED INSURED, at the address stated in Item 1. of the Declarations, written notice stating when, not less than thirty (30)days thereafter(or ten (10) days thereafter for non-payment of premium), such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice.The time of surrender or the effective date and hour of cancellation stated in the notice shall become the end of the POLICY PERIOD. Delivery of such written notice either by the NAMED INSURED or by the Company shall be equivalent to mailing. If this Policy is canceled, earned premium shall be computed in accordance with the Company's guidelines with respect to cancellation. Premium adjustment may be made either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. B. Action Against The Company No action may be brought against the Company unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this Policy, nor until the amount of the INSURED'S obligation to pay shall have been finally determined either by judgment against the INSURED in a contested proceeding after final judgment has been rendered and any appeal decided, or by written agreement of the INSURED, the claimant and the Company. No person or organization shall have any right under this Policy to join the Company as a party to any action against the INSURED to determine the INSURED'S liability, nor shall the INSURED or the INSURED'S legal representative join the Company in such action. Bankruptcy or insolvency of the INSURED or the INSURED'S estate shall not relieve the Company of any of its obligations hereunder. C. Assignment This Policy may not be assigned or transferred without written consent of the Company. D. Subrogation In the event of any payment under this Policy, the Company shall be subrogated to all the INSURED'S rights of recovery therefor against any person or organization, and the INSURED shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The INSURED shall do nothing after a CLAIM(S)to prejudice such rights. However, it is agreed that the Company waives its rights of subrogation under this Policy against clients of the INSURED as respects any CLAIMS) arising from PROFESSIONAL SERVICES, or CONTRACTING SERVICES under the client's contract requiring waiver of subrogation, but only to the extent required by written contract. LDD 050 1116 Page 15 of 16 ®2016 X.L. America, Inc. All Rights Reserved. May not be copied without permission. CERTIFICATE OF LIABILITY INSURANCE DA E(MMi DN Y) THIS CERTIFICATE 1S 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 Gre Iln Edgewood Partners Ins Center PHONE COI Specialist FAX 3780 Mansell Rd. Suite 370 • 770.756.6599 arc No):770.756.6599 Alpharetta GA 30022 Ao6REss: greylingcertsQgreyling.com INSURER(S)AFFORDING COVERAGE NAIC 4 wsURER A:National Union Fire Ins Co of Pittsburg 19445 INSURED INSURERS: Psomas 865 South Figueroa Street INSURERC: Suite 3200 INSURER D: Los Angeles CA 90017 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1522473404 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 ADOL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIALGENERALLIABILITY GL526EI212 411/2026 4/112027 EACH OCCURRENCE $2.000.000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea ccurrencel $50U,000 MED EXP(Any one porsan) $25,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY JECT LOC PRODUCTS-COMPIOPAGG 54,000,000 OTHER: $ A AUTOMOBILE LIABILITY CA4489706 4/1/2026 4/1/2027 COMBINEDSINGLELIMIT $2,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC72113158(AOS) 411/2026 41112027 X STATUTE ERH A AND EMPLOYERS'LIABILITY YIN WC72113159(CA) 4r1r2026 4/112027 ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICERIMEM6EREXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,006,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 2SAN051701;Santa Ana Agreement for RFP A-2023-075-07 On-call Engineering Services. City of Santa Ana its officers,officials,employees,and volunteers are named as Additional Insureds with respects to General&Automobile Liability where required by written contract.The above referenced liability policies are primary&non-contributory where required by written contract.Waiver of Subrogation in favor of Additional Insured(s)where required by written contract&allowed by law.Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof,we will endeavor to provide 30 days'written notice(except 10 days for nonpayment of premium)to the Certificate Holder. APPROVED -- - CERTIFICATE HOLDER CANCELLATION By ru Tran Nguyen of 11:59 am,Apr 06,2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Public Works Agency Santa Ana CA 92702-1988 AUTHORIZED REPRESENTATIVE/ jJ�_fir/ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ENDORSEMENT This endorsement, effective 12:01 A.M. 04/01/2026 forms a part of Policy No. CA4489706 issued to Psomas by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON'S ORO ORGANIZATION'S LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO" . I. SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. AUTHORIZED REPRESENTATIVE 87950 (9114) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 04/01/2026 forms a part of Policy No. CA4489706 issued to Psomas by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident' or "loss" if: (1) The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2) The contract or agreement was entered into prior to any "accident' or "loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. AUTHORIZE© REPRESENTATIVE 62897 (6/95) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 POLICY NUMBER: GL5268212 COMMERCIAL GENERAL LIABILITY 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 WHOM YOU PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 2 ❑ A. Section II - Who Is An Insured is amended to maintenance or repairs) to be performed by include as an additional insured the person(s) or or on behalf of the additional insured(s) at organization(s) shown in the Schedule, but only the location of the covered operations has with respect to liability for "bodily injury", been completed; or "property damage" or "personal and advertising 2. That portion of "your work" out of which injury" caused, in whole or in part, by: the injury or damage arises has been put to 1. Your acts or omissions; or its intended use by any person or 2. The acts or omissions of those acting on organization other than another contractor or your behalf; subcontractor engaged in performing in the performance of your ongoing operations operations for a principal as a part of the same project. for the additional insured(s) at the locations) designated above. C. With respect to the insurance afforded to these additional insureds, the following is added to However: Section III - Limits Of Insurance: 1. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted by law; and required by a contract or agreement, the most we will pay on behalf of the additional insured 2. If coverage provided to the additional is the amount of insurance: insured is required by a contract or agreement, the insurance afforded to such 1. Required by the contract or agreement; or additional insured will not be broader than 2. Available under the applicable limits of that which you are required by the contract insurance; or agreement to provide for such additional whichever is less. insured. This endorsement shall not increase the B. With respect to the insurance afforded to these applicable limits of insurance. 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, Page 2 of 2 0 Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: GL5268212 COMMERCIAL GENERAL LIABILITY 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or B. With respect to the insurance afforded to organization(s) shown in the Schedule, but only these additional insureds, the following is with respect to liability for "bodily injury" or added to Section III - Limits Of Insurance: "property damage" caused, in whole or in part, If coverage provided to the additional insured is by "your work" at the location designated and required by a contract or agreement, the most described in the Schedule of this endorsement we will pay on behalf of the additional insured performed for that additional insured and is the amount of insurance: included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted whichever is less. by law; and This endorsement shall not increase the 2. If coverage provided to the additional applicable limits of insurance. 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. CG 20 37 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 526-82-12 COMMERCIAL GENERAL LIABILITY CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): ANY PREMISES OR PART THEREOF LEASED TO YOU. Name Of Person(s) Or Organization(s) (Additional Insured): ANY PERSON OR ORGANIZATION FROM WHOM YOU LEASE PREMISES OR WHO MANAGES PREMISES YOU OWN AND TO WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED UNDER THIS POLICY AS A RESULT OF ANY LEASE OR MANAGEMENT AGREEMENT YOU ENTER INTO WITH SUCH PARTIES. Additional Premium: $ 0 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 acting on your behalf in connection with the include as an additional insured the person(s) or ownership, maintenance or use of that part of organization(s) shown in the Schedule, but only the premises leased to you and shown in the with respect to liability for "bodily injury", Schedule and subject to the following additional "property damage" or "personal and advertising exclusions: injury" caused, in whole or in part, by you or those CG 20 11 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 2 This insurance does not apply to: B. With respect to the insurance afforded to these 1. Any "occurrence" which takes place after additional insureds, the following is added to you cease to be a tenant in that premises. Section III - Limits Of Insurance: 2. Structural alterations, new construction or If coverage provided to the additional insured is demolition operations performed by or on required by a contract or agreement, the most behalf of the persons} or organization(s) we will pay on behalf of the additional insured shown in the Schedule. is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2• Available under the applicable limits of insured only applies to the extent permitted insurance; by law; and whichever is less. 2. If coverage provided to the additional This endorsement shall not increase the insured is required by a contract or applicable limits of insurance. 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. Page 2 of 2 0 Insurance Services Office, Inc., 2018 CG 20 11 12 19 POLICY NUMBER: GL5268212 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 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 SCHEDULE Name Of Person(s) Or Organization(s): PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such personas? or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "a(taching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 04/01/2026 forms a part of Policy No. WC WC72113159 (CA) Issued to Psomas By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned by - - - - - ` - - - - - - - - - - - - - Authorized Representative