HomeMy WebLinkAboutUNITED STORM WATER, INC. 6C • AGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in effect.
Return form to the Deputy Clerk of the Council (M-30). Call 647-5238 if you have any questions.
The agreement with United Stormwater, Inc.
No. 2013-114-03 was completed on June 30, 2017
and final payment has been made.
Department: PWA/Construction Engineering
. 0.-----
Signature:
Date: May 11, 2020
City of Santa Ana
Clerk of the Council
Revised 05-22-08
Eduardo Perry, Jr.
United Storm Water, Inc.
1400 E Valley View Blvd.
City of Industry, California 91746
Re: Agreement A- 2012 -105, "Contractor Agreement' Extension
Dear Mr. Perry:
A-2013-114-02
Pursuant to Agreement A -2012 -105, entered by United Storm Water, Inc., and the City of Santa Ana,
dated June 4, 2012, as amended by Agreement A- 2013 -114 and Agreement A -2013- 114 -01, Section 4
"Term ", the time period of said Agreement is hereby extended for an additional one (1) year period,
through June 30, 2016. All other terms and conditions of said Agreement remain unchanged and in full
force and effect.
Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well as
California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws "), which require
the payment of prevailing wage rates and the performance of other requirements on "public works" and
"maintenance" projects. Contractor agrees to fully comply with such Prevailing Wage Laws. Insurance
certificates are required to be extended and/or renewed to cover this extension.
If you have any questions, please contact Thomas Lo in the Public Works Agency at 714- 647 -5659.
Since ly,
Fre ousavipour
Executive Director
Public Works Agency
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
o Sandoval
C of Assistant City Attorney
c: Clerk of the Council
CITY OF SANTA ANA
David Cavazos
ATTEST:
Maria D. Huizar
Clerk of the Council
SANTA ANA CITY COUNCIL
-7
Miguel A, Pulido li Vincent F. Sarmonto Michele Martlnaz Angellaa Amemua 'iI P. David 6enavld0.a Roman Reyna Sal Tlnaiwro
Mayor Mayor Pro Tom, Ward 1 pA�tl' Ward Ward Ward Wards Ward
Maoli G�sante -ana or o Vearrri e t2& t - q yyyyd,[hrmZ �aama -arid or AA Col to A4W,.2a Deend, d.e rOSeaWlne� RRev— R-yrggAnaT g aT nSgrpu
Ana.o[g
INSURANCE ON FILE
WORK MAY PROCEED
MAYOR
UNTIL INSURANCE EXPIRES
Miguel A. Pulido
MAYOR PRO TEM of 8 00
Vincent F. SarmientOLERK OF COUNCIL w
DATE:
COUNCILMEMBERs
Angelica Amezcua
P. David Benavides
,�--^^��,,�9¢(
r„r - I�Yv�N�
Michele Martinez
Roman Reyna
--
SalTinajero
CITY OF SANTA ANA
PUBLIC WORKS AGENCY
20 Civic Center Plaza M -36 e P.O. Box 1988 M -36
Santa Ana, California 92702
w rrsanta- ana.org
June 17, 2015
Eduardo Perry, Jr.
United Storm Water, Inc.
1400 E Valley View Blvd.
City of Industry, California 91746
Re: Agreement A- 2012 -105, "Contractor Agreement' Extension
Dear Mr. Perry:
A-2013-114-02
Pursuant to Agreement A -2012 -105, entered by United Storm Water, Inc., and the City of Santa Ana,
dated June 4, 2012, as amended by Agreement A- 2013 -114 and Agreement A -2013- 114 -01, Section 4
"Term ", the time period of said Agreement is hereby extended for an additional one (1) year period,
through June 30, 2016. All other terms and conditions of said Agreement remain unchanged and in full
force and effect.
Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well as
California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws "), which require
the payment of prevailing wage rates and the performance of other requirements on "public works" and
"maintenance" projects. Contractor agrees to fully comply with such Prevailing Wage Laws. Insurance
certificates are required to be extended and/or renewed to cover this extension.
If you have any questions, please contact Thomas Lo in the Public Works Agency at 714- 647 -5659.
Since ly,
Fre ousavipour
Executive Director
Public Works Agency
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
o Sandoval
C of Assistant City Attorney
c: Clerk of the Council
CITY OF SANTA ANA
David Cavazos
ATTEST:
Maria D. Huizar
Clerk of the Council
SANTA ANA CITY COUNCIL
-7
Miguel A, Pulido li Vincent F. Sarmonto Michele Martlnaz Angellaa Amemua 'iI P. David 6enavld0.a Roman Reyna Sal Tlnaiwro
Mayor Mayor Pro Tom, Ward 1 pA�tl' Ward Ward Ward Wards Ward
Maoli G�sante -ana or o Vearrri e t2& t - q yyyyd,[hrmZ �aama -arid or AA Col to A4W,.2a Deend, d.e rOSeaWlne� RRev— R-yrggAnaT g aT nSgrpu
Ana.o[g
n® CERTIFICATE OF LIABILITY INSURANCE
F DATE YY)
1 /16/2015
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 pollcy(ies) must 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 endors humor( s).
PRODUCER Bolton & Company
3475 E. Foothill Blvd., Suite 100
Pasadena, CA 91107
CON AC
_
PHONE "— FAX
(626) 799- 7000- A C No): (626) 583„ -2117
E-MAIL _..__.- - „ -__,
ADDRESS,
INSURERS AFFORDING COVERAGE
NAIC p
✓
INSURERA: Steadfast Insurance Company
GPLOO8626700
www,boltonco.com 0008309
INSURED
United PumpiN Service, Inc.
United Storm VV ater, Inc.
INSURER B: Zurich American Insurance Company
$ 1,000,000
---- ----- — —�
INSURER C:
CLAIMS -MADE OCCUR
INSURER D:
4 Lease Inc.
14000 ffast Valley Blvd.
City of Industry CA 91746
INSURER E:
INSURER F
TO -RENTD
PREMISES E. ocr.ence
COVERAGES CERTIFICATE NUMBER: 23093655 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
R
TYPE OF INSURANCE
INSD ADDLSUBR
MIT
POLICY NUMBER
MMIDDY�
MMDDY�
LIMITS
COMMERCIAL GENERALUABILITY
✓
GPLOO8626700
12/31/2014
12/3112015
EACHOCCURRENCE
$ 1,000,000
CLAIMS -MADE OCCUR
TO -RENTD
PREMISES E. ocr.ence
$ 50,000
MED EXP (Any one person )
$ 5,000
PERSONAL& ADS INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$ 4,000,000
POLICY Z PRO-
JECT E LOG
PRODUCTS- COMP /OP AGG
$ 2,000,000
$
OTHER:
B
AUTOMOBILE
LIABILITY
BAP008625100
12131/2014
12/31/2015
EOMBINEDS INGLE LIMIT
$ 1.000.000
BODILY INJURY (Per person)
$
✓
ANYAUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
✓
NON-OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Peraccident
$
A
UMBRELLA LIAB
OCCUR
SXS008626800
12/31/2014
12/31/2015
EACH OCCURRENCE
$ 9000000
AGGREGATE
$ 9,000,000
,/
EXCESS LIAB
CLAIMS -MADE
DED
✓
RETENTION$0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
WC008625000
12/31/2014
12/31/2015
PER UT 'EA”-
E.L. EACH ACCIDENT
$ 1,090,009
OFFICERIMEMBER EXCLUDED?
(Mandatory, in NH)
EL .DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Pollution Liability
GPLODS626700
12/31/2014
12131/2015
1,000,000 Each Claim
A
Professional Liab - Claims Made
GPLOO8626700
12131/2014
12131/2015
1,000,000 Each Claim
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is reed !red)
GL Additional Insured and Primary & Non - Contributory wording applies per the STFESP101 ECW0910 attached as required by wirtten contract.
Re: Operations of the Named Insured. Additional Insured(s): City of Santa Ana,/a, its officers, agents, volunteers and employees.
UNITED STORM WATER A- 2013 - 114 -01 REVIEWED BY:zq> , (� EUNICE HEREDIA (PG. 1 of 4)
City of Santa Ana
Public Works Department
20 Civic Center Plaza M -36
Santa Ana CA 92701
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
I
reserved.
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD
CERT NO.: 23093655 CLIENT COU£: UN17PUM -01 Naacy Cadwallader 1/16/2015 3:3'1:41 PM (PST) Page 1 of I
Additional Insured - Automatic - Owners, Lessees Or
Contractors
Coverage Part One - Commercial General Liability
Coverage Part Two - Contractor's Pollution Liability
ZURICH
Policy No.
Eff. Date of Pol.
Exp. Data of Pol.
Producer
Audi Prem.
Return Prom,
12/3112015
�Eff.DateofEnd.
75223000
Named Insured and Mailing Address:
UNITED PUMPING SERVICE, INC.
14000 VALLEY BLVD
CITY OF INDUSTRY, CA 91746 -2801
Producer:
BOLTON & COMPANY
PO BOX 6030
PASADENA, CA 91102 -6030
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
Environmental Services Package Policy
❑X COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY
COVERAGE PART TWO- CONTRACTOR'S POLLUTION LIABILITY
1. Who is an Insured (Section I.) in the COMMON COVERAGE PROVISIONS is amended to include as an insured any
person or organization whom you are required to add as an additional insured on this policy under a written contract
or written agreement.
2. The insurance provided to the additional insured person or organization applies only to:
a. "Bodily injury ", "property damage' or "personal and advertising injury" under COVERAGE PART
ONE - COMMERCIAL GENERAL LIABILITY, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE
LIABILITY and COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY caused, in whole or in part,
by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf;
and resulting directly from:
(a) Your ongoing operations performed for the additional insured, which is the subject of the written contract
or written agreement; or
(b) "Your work" completed as included in the "products- completed operations hazard ", performed for the
additional insured, which is the subject of the written contract or written agreement; and /or
b. "Claims" arising out of a "pollution event" under COVERAGE PART TWO - CONTRACTOR'S POLLUTION
LIABILITY, caused, in whole or in part, by:
(1) Your acts or omissions; or
STF -ESP -101 -E CW (09110)
/��111/fff Page 1 of 3
UNITED STORM WATER A -2013- 114 -01 REVIEWED BY:1 G "G'`r .. EUNICE NEREDIA (PG. 2 of 4)
CERT N0. 23093655 CLIENT C'OO t': IINITPIIl1 -01 Nancy CadW"llader 1/16/2015 3:37 :41 PM (PM Page 2 of 4
(2) The acts or omissions of those acting on your behalf,
and resulting directly from:
(a) "Covered operations" performed for the additional insured, which is the subject of the written contract or
written agreement; or
(b) "Completed operations" of the "covered operations" performed for the additional insured, which is the
subject of the written contract or written agreement.
3. However, regardless of the provisions of paragraphs 1. and 2. above:
a. We will not extend any insurance coverage to any additional insured person or organization:
(1) That is not provided to you in this policy; or
(2) That is broader coverage than you are required to provide to the additional insured person or organization in
the written contract or written agreement; and
b. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of:
(1) The Limits of Insurance provided to you in this policy; or
(2) The Limits of Insurance you are required to provide in the written contract or written agreement.
4. The insurance provided to the additional Insured person or organization does not apply to:
"Bodily injury ", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render
any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field
orders, change orders or drawings and specifications; and
b. Supervisory, inspection, architectural or engineering activities.
5. The additional insured must see to it that:
a. We are notified as soon as practicable of an 'occurrence ", offense or "pollution event', as applicable, that may
result in a claim;
b. We receive written notice of a claim or "suit" as soon as practicable; and
c. A request for defense and indemnity of the claim or "suit' will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured, if the written contract or written
agreement requires that this coverage be primary and non - contributory.
6. For the coverage provided by this endorsement:
a. The following paragraph is added to Paragraph 8.a. Other Insurance, Conditions (Section V.) in the COMMON
COVERAGE PROVISIONS:
This insurance is primary insurance as respects our coverage to the additional insured person or organization,
where the written contract or written agreement requires that this insurance be primary and non - contributory with
respect to any other policy upon which the additional Insured is a Named Insured, In that event, we will not seek
contribution from any other such insurance policy available to the additional insured on which the additional
insured person or organization is a Named Insured.
b. The following paragraph is added to Paragraph 8.b. Other Insurance, Conditions (Section V,) in the COMMON
COVERAGE PROVISIONS:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same 'occurrence ", offense, claim or "suit'. This provision does not apply to any
STF- ESP -101 -E CW (09/10)
Page 2 of 3
UNITED STORM WATER A- 2013 - 114 -01 REVIEWED By: 4 . 44 A EUNICE HEREDIA (PG. 3 of 4)
11,FT .1., 210 IG54 CLIENT lov" UeN 11l(,1-01 Nancy Cxdwallades 1/16/2010 331:11 PM (P9, f,, i of 9
policy in which the additional insured is a Named Insured on such other policy and where our policy is required by
written contract or written agreement to provide coverage to the additional insured on a primary and
non - contributory basis.
7. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional Insureds, and which endorsement applies specifically to
that identified additional Insured.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
STF- ESP -101 -E CW (09/10)
Page 3 of 3
UNITED STORM WATER A -2013- 114 -01 REVIEWED Sy: i? G! EUNICE HEREDIA (PG. 4 of 4)
CGR.' V0.: P109365S CLIFF C006: M'TPUM -01 Nancy Cadwalladee 1/16/0:5 3:37:91 PM (PSTI Page 4 of 4
A'C®R& CERTIFICATE OF LIABILITY INSURANCE
1"i
DATE(MMIDD /YYYY)
1 1/21/2016
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 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 Bolton & Company
3475 E. Foothill Blvd., Suite 100
Pasadena, CA 91107
CONTACT
NAME:
PHONE FAX
A/C No Ext : 626 799 -7000 A/c No : 626 583 -2117
E -MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
www.boltonco.com 0008309
INSURERA: Steadfast Insurance Company
26387
INSURED
United Pumping Service, Inc.
United Storm Water, Inc.
INSURER 13: Zurich American Insurance Company
16535
INSURERC:
EACH OCCURRENCE
4 Lease, Inc.
14000 East Valley Blvd.
City of Industry CA 91746
INSURER D:
PREM SES (Ea occurrence)
INSURER E:
INSURER F
$ 5,000
MWWWAA-cl� -JYUCV ra.v.1urde -J- -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
SD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM /DD /YYYY
POLICY EXP
MM /DD/YYYY
LIMITS
A
�/
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
✓
GPL008626701
12/31/2015
12/31/2016
EACH OCCURRENCE
$ 1,000,000
PREM SES (Ea occurrence)
$ 50,006
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1 ,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PEO LOG
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMP /OP AGO
$ 2,600,006
F
$
OTHER:
B
AUTOMOBILE
LIABILITY
BAP008625101
12/31/2015
12/31/2016
MB,1NEDtSINGLELIMIT
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY Per accident
( )
$
✓
NON -OWNED
HIRED AUTOS ✓ AUTOS
PROPERTY DAMAGE
Per accident
$
Died Comp & Collision
$ 1,000
A
UMBRELLALIAB
✓
OCCUR
SXS008626801
12/31/2015
12/31/2016
EACH OCCURRENCE
$ 11,000,000
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$ 11,000,000
DED ✓ RETENTION $0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED? ❑N
NIA
WC008625001
12/31/2015
12/31/2016
PER OTH-
✓ STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS below
A
Pollution Liability
GPL008626701
12/31/2015
12/31/2016
1,000,000 Each Claim
A
Professional Liab - Claims Made
GPL008626701
12/31/2015
12/31/2016
1,000,000 Each Claim
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Agreement #A-2013-114-02
GL Additional Insured and Primary & Non - Contributory wording applies per STFESP101 ECW0910 attached as required by wirtten contract.
Additional Insured(s): City of Santa Ana, its officers, agents, volunteers and employees.
REVIEWED BY: EUNICE HEREDIA (PG OF ) ,
City of Santa Ana
Public Works Department
20 Civic Center Plaza M -36
Santa Ana, CA 92701
td
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Cassandra Rosales
U 19BB -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
28233710 1 IJNITPUM -01 1 15 -16 GL, Auto, Umb, WC, POLL, Prof Liab I Ali.. Lopez 1 1/21/2016 4:56:02 PM (PST) I Page 1 of 4
Additional Insured-Automatic-Owners, Lessees Or
Contractors
Coverage Part One - Commercial General Liability
Coverage Part Two- Contractor's Pollution Liability
ZURICH
Policy No.
Eff. Date of Pol.
Exp. Date of Pol.
Eff. Date of End.
Producer
Add'I Prem.
Return Prem,
G PL008626701
12/31/2015
12/31/2016
7szz3000
Named Insured and Mailing Address:
UNITED PUMPING SERVICE, INC.
14000 VALLEY BLVD
CITY OF INDUSTRY, CA 91746 -2801
Producer:
BOLTON & COMPANY
PO BOX 6030
PASADENA, CA 91102 -6030
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
Environmental Services Package Policy
® COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY
IN COVERAGE PART TWO - CONTRACTOR'S POLLUTION LIABILITY
1. Who is an Insured (Section I.) in the COMMON COVERAGE PROVISIONS is amended to include as an insured any
person or organization whom you are required to add as an additional insured on this policy under a written contract
or written agreement.
2. The insurance provided to the additional insured person or organization applies only to:
a. "Bodily injury ", "property damage" or "personal and advertising injury" under COVERAGE PART
ONE- COMMERCIAL GENERAL LIABILITY, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE
LIABILITY and COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY caused, in whole or in part,
by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf;
and resulting directly from:
(a) Your ongoing operations performed for the additional insured, which is the subject of the written contract
or written agreement; or
(b) "Your work" completed as included in the "products- completed operations hazard ", performed for the
additional insured, which is the subject of the written contract or written agreement; and /or
b. "Claims" arising out of a "pollution event" under COVERAGE PART TWO - CONTRACTOR'S POLLUTION
LIABILITY, caused, in whole or in part, by:
(1) Your acts or omissions; or
/ STF- ESP -101 -E CW (09/10)
/ Page 1 of 3
i`! f
REVIEWED BY: j 101. l� - EUNICE HEREDIA (PG" OF )
28233710 1 UNITPU14 -01 1 15 -16 GL, Auto, Umb, WC, POLL, Prof Liab I Alisa Lopez 1 1/21/2016 4:56:02 PM (PST) I Page 2 of 4
(2) The acts or omissions of those acting on your behalf,
and resulting directly from:
(a) "Covered operations" performed for the additional insured, which is the subject of the written contract or
written agreement; or
(b) "Completed operations" of the "covered operations" performed for the additional insured, which is the
subject of the written contract or written agreement.
3. However, regardless of the provisions of paragraphs 1. and 2. above:
a. We will not extend any insurance coverage to any additional insured person or organization:
(1) That is not provided to you in this policy; or
(2) That is broader coverage than you are required to provide to the additional insured person or organization in
the written contract or written agreement; and
b. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of:
(1) The Limits of Insurance provided to you in this policy; or
(2) The Limits of Insurance you are required to provide in the written contract or written agreement.
4. The insurance provided to the additional insured person or organization does not apply to:
"Bodily injury ", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render
any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field
orders, change orders or drawings and specifications; and
b. Supervisory, inspection, architectural or engineering activities.
5. The additional insured must see to it that:
a. We are notified as soon as practicable of an 'occurrence ", offense or "pollution event ", as applicable, that may
result in a claim;
b. We receive written notice of a claim or "suit" as soon as practicable; and
c. A request for defense and indemnity of the claim or "suit' will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured, if the written contract or written
agreement requires that this coverage be primary and non - contributory.
6. For the coverage provided by this endorsement:
a. The following paragraph is added to Paragraph 8.a. Other Insurance, Conditions (Section V.) in the COMMON
COVERAGE PROVISIONS:
This insurance is primary insurance as respects our coverage to the additional insured person or organization,
where the written contract or written agreement requires that this insurance be primary and non - contributory with
respect to any other policy upon which the additional insured is a Named Insured. In that event, we will not seek
contribution from any other such insurance policy available to the additional insured on which the additional
insured person or organization is a Named Insured.
b. The following paragraph is added to Paragraph 8.b. Other Insurance, Conditions (Section V.) in the COMMON
COVERAGE PROVISIONS:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same 'occurrence ", offense, claim or "suit'. This provision does not apply to any
STF- ESP -101 -E CW (09/10)
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REVIEWED BY: 177 r EUNICE HEREDIA (PG , OF )
28233710 1 UNITPUM -01 1 15 -16 GL, Auto, UMW, WC, POLL, Prof LiaU i A1isa Lopez 1 1/21/2016 4:56:02 PM (PST) i Page 3 of 4
policy in which the additional insured iao Named Insured onsuch other policy and where our policy iarequired by
written contract or written agreement to provide coverage to the additional insured on a primary and
non-contributory basis.
7. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in o Schedule of additional inouredo, and which endorsement applies specifically to
that identified additional insured.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
aTF-EoP-101'smm(09x0)
Page 3 of 3
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