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HomeMy WebLinkAboutRJM DESIGN GROUP INC.City of Santa A, a r t Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with (' J 114 COTC Office Use Only � Cie V No. � �b ��_ �� was completed on and final payment has been made. (List all amendments. Use space below if needed.) J 0/7 A)-7 63 2> Revised: 01-07-16 Department: G- i oe Phone/Ext.: Signature: -?74 " r✓�� / 1 6� Date: Ja.7ct� G+abrltl July 18, 2017 Mr. Robert J. Mueting, Principal RJM Design Group 31591. Camino Capistrano San Juan Capistrano, CA 92675 Reference: Third Extension of Consultant Agreement No. A-2014-223 Dear Mr. Mueting: Pursuant to Section 5 of Agreement No. A-2014-223, entered into by RIM Design Group and the City of Santa Ana, dated September 16, 2014, the term of the Agreement is hereby extended for an additional one (1) year period through September 30, 2018 to cover existing services that are on-going on the date of this extension. The 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. Sinely Fred Mousavipour Executive Director Public Works Agency CITY OFrANd Cynthia J. Kurtz ^ _ Acting City Manager APPROVED AS TO FORM Jen M. Funk Assistant City Attorney ATTEST Ma�iluizar� Clerk of the Council �— SANTA ANA CITY COUNCIL Miguel't, Pulldo Michele Martinez i Vicente Sarmlento i Jose Solodo l P. David Benavrdes i Juan Villages I Sal Tinelero Mayor [ Mayor Pro Tem, Ward 2 1 Wand Ward3 i Ward4 i wards i Wards MPurdoGdsanbs an o:J i YSarmiEntafo7tia ia,.anaop d5o[ !r� t L'yynrEyl'Iys:o3eantaananra i Il me ( 'nir i crt nte-na om A-2014.223-03 INSURANCE NOT ON FILE MAYOR WORK MAY NOT PROCEED__.. Miguel A. Putdo MAYOR PRO TEM tt CLER j(p�} COUNCIL Cynthia J. Kurtz CITY ATTORNEY Michele Martinez DAWE 0 9 2017 m Sonia R. Carvalho COUNCILMEMBERS CLERK OF THE COUNCIL P. David Benavides Marla D. Huizar Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villages CITY OF SANTA ANA 20 Civic Center Plaza e P.O. Box 1988 Santa Ana, California 92702 ' W i) www.santa-ana.org Ja.7ct� G+abrltl July 18, 2017 Mr. Robert J. Mueting, Principal RJM Design Group 31591. Camino Capistrano San Juan Capistrano, CA 92675 Reference: Third Extension of Consultant Agreement No. A-2014-223 Dear Mr. Mueting: Pursuant to Section 5 of Agreement No. A-2014-223, entered into by RIM Design Group and the City of Santa Ana, dated September 16, 2014, the term of the Agreement is hereby extended for an additional one (1) year period through September 30, 2018 to cover existing services that are on-going on the date of this extension. The 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. Sinely Fred Mousavipour Executive Director Public Works Agency CITY OFrANd Cynthia J. Kurtz ^ _ Acting City Manager APPROVED AS TO FORM Jen M. Funk Assistant City Attorney ATTEST Ma�iluizar� Clerk of the Council �— SANTA ANA CITY COUNCIL Miguel't, Pulldo Michele Martinez i Vicente Sarmlento i Jose Solodo l P. David Benavrdes i Juan Villages I Sal Tinelero Mayor [ Mayor Pro Tem, Ward 2 1 Wand Ward3 i Ward4 i wards i Wards MPurdoGdsanbs an o:J i YSarmiEntafo7tia ia,.anaop d5o[ !r� t L'yynrEyl'Iys:o3eantaananra i Il me ( 'nir i crt nte-na om RJMDESI-01 "Ic" CERTIFICATE OF LIABILITY INSURANCE DATE 10/17/201 YY) �--�''� 10/17/2017 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 License # OE67768 % CONTACT Ali Smith 1 NAME: IOA Insurance Services PHONE FAX 4370 La Jolla Village Drive (A/C No, Ext)No):(619) 574 _ (619) 788-5795 50206 (A/C, -6288 E-MAIL Ali .Smith@loausa com Suite 600 ADDRESS:___ San Diego, CA 92122 -- - INSURED RJM Design Group, Inc. 31591 Camino Capistrano San Juan Capistrano, CA 92675 INSURER A : RLI Insurance C INSURERB: Arch Insurance INSURER C: E: F: rnAIPPAMPQ CGGTIVIL`ATG NII INA9:11=0- DC\/ICIPMI All IRAQCO. 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 ADDDL SUER POLICY NUMBER POLICY EFF PMMIDDIYYYYI IOLICY EXP LIMITS A X 1. COMMERCIAL GENERAL LIABILITY2,000,000 EACH OCCURRENCE $ 1 CLAIMS -MADE X OCCUR X PSB0007263 09/30/2017 09/30/2018 DAMAGES Ea GE TO RENTED TE ante) $ 1,000'000 X Cont Llab/SeV of Int 10,000 ..... _ MED -EXP (Any one person)_ $ __._. PERSONAL 8 ADV INJURY $ -- —..... 2,000,000 1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE. $ _ ------ -------- 4,000,000 POLICY X l JET LOC PRODUCTS - COMP/OP AGG $ 4,000,000 Deductible 0 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO PSA0002412 X 09/30/2017 09/30!2018 BODILY INJURY (Per person) $ I OWNED SCHEDULED AUTOS ONLY ; AUTNOS BODILY INJURY (Per, accident) $ _ Ep X AUTOS ONLY X.._ AUOTOS ONtJLY PROPERTY AMAGE No Co. Ownedaccident X f Autos $ A X UMBRELLA LIAB OCCUREACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS -MADE PSE0003628 09/30/2017 09/30/2018 AGGREGATE $ 1,000,000 DEDI' RETENTION $ $ - ... A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY PER OTH- .-STATUTE '.. ER ,.. _. Y / N ANY PROPRIETOR/PARTNER ExEcunvE X ',PSW0004066 09/30/2017 09/30/2018 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA - (Mandatory in NH)E.L.DISEASE ._ - EA EMPLOYEE $ 1,000,000 yes, describe under '. DESCRIPTION OF OPERATIONS below D ' � E.L. DISEASE -POLICY LIMIT $ 1�000,000 B !:Prof Liab/Clms Made PAAEP0031100 10/01/2017', 10/01/2018 Per Claim 2,000,000 B Ded.: $25k Per Claim PAAEP0031100 10/01/2017 10/01/2018 ;Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: A-2009-023 and A-2014-223-03 The City of Santa Ana, its officers, employees and representatives are Additional Insureds with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation. 30 Days Notice of Cancellation with 10 pays Notice for Non -Payment of Premium in accordance with the policy pr isions. REVIEWEC) BY: EUNIC,E HEREDIA (PG � OF ) City of Santa Ana Attn: Susie Furjanic PO Box 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Named Insured: RJM Design Group, Inc. Policy Number: PSB0007263 RLI ArIsUrahco.6ofripany THIS ENDOKSEIV116ENT 6HANOES. THE POLICY'. PLEASE READ IT OAREFULLY, RLIPUK•FOR DESIGN MOPEMONALS BLANKET ADDITIONAL I*N$UR.E.D ENDQRSEMENT This Ondotseihi,6ht modifieis insurance provided under the fdllcjWlng: %JSINES,50WNER�, COVERAGE FORM -,SECTION 11 — LIABILITY C. WHO IS AN INSURED is amended to include as an,additinnal Insured any person or organization that yc:u agree In a 'contract or agreement requiring insurance to include: as,an additional insured -6h this policy, but only with respect to liability for "bodily Injury", "property damage" (Jr. "Personal and adv6rtisInq-lhjury" oauis6d IN Whole or in -part by you or thoge.ecting on*yoor behalf: a'. In the ,performance of your ongoing operations: b. In connection with premises owned by or rented to ybU,' or r.. In nonn'p6tihn with "your' Work" And InoWdPA Within the "produbkompletedoperations 2. The insurance provided to the addltlonW. Insured by this endorsement'is limited as follows: a. This insurance,idoes not apply on any basis to any p4mbh or .666nlzeitlon for whi6h o6viarage as an addition'al Iftured, specifically is added by another:end6rs6ment to this pollby. b. This insurance -does not apply'to the. rendering of or failure to render any "professional services". c. This endorsement dbes not increase any of the limits of insurance -stated In D. Liability And Medical Expenses Limits of Insurance. 3, The rolluwlrig is adde'd to: SECTION III H.2, Other Insurance , COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION 11 — LiAaILITV). However., if you specifically agree In a contract or agreement -that- :the insurance provided to an PIP0. �,04 06 IQ additional insured under this pblloy'mUst a'oply on a primary basis, or a. primary and non-contributory Oasis, this. insuraniod ls.priMary to other Insutanoe that Is available to such additional InWrdd Which covers such additional insured 'as a, named Insured, .and we will not shate 'with that other lh,$Urance, Provided that: a. The "bodily Injury" or "pr6perty dbmqge" for which coverage Is sought occurs'after,y6u have witui.ed lulu thdt (;Ur*muL.o(ayi'Vemeri( ui b. The "personal ..and advertising injury" .for whlob c=la� sought arises out' of an offense 0 after you. ttave entered Into that contract or gigrbeiment, 4. The following is added to SECTION 111 K. 2. *Transfer of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION 11 — LIABILITY) We Waive any rights of redov"_ we may have agaCmst any person or, orgaNzationi because of Pdytnonte wo rrakb for "b6dily injury", "Orcip6rty damage." or "personal and advertising Injury" arising out of `.Vour'work" performed by you, 'or, on your behalf, under a. contre6t or agreement -With that person or oroanlz6tion, We waive these rights only where you have agreed to do so as part of a -contract' or V06Meht 'With such pbfth or brganizatiori• entered into by -you befoie the "bodily injury" 0 "property damage" occurs, or tho "pomonal and gdvertisihg injury" offense 16 coffimitted. ALL OTHERT-ERms AND CONbITIONSdF THIS POLICY REMAIN. UNCHANQED, Page 1 ol; 1 REVIEWED BY: EUNICE HEREDIA (PG 2 OFq) Named Insured: RJM Design Group, Inc. Policy Number: PSA0002412 This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. Broad Form Named Insured The following is added to the SECTION it - COVERED AUTOS LIABILITY COVERAGE, Para- graph A.I. Who Is An Insured Provision: Any business entity newly acquired or formed by you during the policy period, provided you own fifty percent (50%) or more of the business entity and the business entity Is not separately insured for Bus- iness Auto Coverage. Coverage is extended up to a maximum of one hundred eighty (180) days following the acquisition or formation of the business entity. This provision does not apply to any person or organization for which coverage is excluded by endorsement. B. Employees As Insureds The following is added to the SECTION II - COVERED AUTOS LIABILITY COVERAGE, Para- graph A.1. Who is An Insured Provision; Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. Blanket Additional Insured The following is added to the SECTION II - COVERED AUTOS LIABILITY COVERAGE, Para- graph A.1. Who Is An Insured Provision: Any person or organization that you are required to Include as an additional insured on this coverage form in a contract or agreement that Is executed by you before the "bodily injury" or "property damage" ocours Is, an "Insured" for liability coverage, but only for damages to whioh this insurance applies and only to the extent that person or organization qualifies as an "Insured" under the Who Is An Insured provision contained in SECTION It - COVERED AUTOS LIABILITY COVERAGE. The Insurance provided to the additional Insured will be on a primary and non-contributory basis to the additional insured's own business auto coverage if you are required to do so in a contract or agreement that is executed by you before the "bodily injury" or "property damage" ocours. D. Blanket Waiver Of Subrogation The following is added to the SECTION IV -- BUSI- NESS AUTO CONDITIONS, A, Loss Conditions, S. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against any person or organization to the extent required of you by a contract executed prior to any "accident" or PPA 300 0313 "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. E. Employee Hired Autos 1. The following is added to the SECTION 11 - COVERED AUTOS LIABILITY COVERAGE, Paragraph AM. Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes In General Conditions: Paragraph S.b. of the Other Insurance Con» dition in the BUSINESS AUTO CONDITIONS is deleted and replaced with the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". F. Fellow Employee Coverage SECTION It - COVERED AUTOS LIABILITY COVERAGE, Exclusion B.S. does not apply if you have workers compensation insurance in -force covering all of your employees. G. Auto Loan Lease Gap Coverage SECTION III - PHYSICAL DAMAGE COVERAGE, C. Limit Of Insurance, is amended by the addition of the following: In the event of a total "loss" to a covered "auto" shown in the Schedule of Declarations, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: 1. The amount paid under the PHYSICAL DAMAGE COVERAGE section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of the "loss"; r-EUNIC-E H-EREDIA LPG, P OF Named Insured: RJM Design Group, Inc. Policy Number: PSW0004066 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4.84) WAIVI=R OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration, Person or Organization All persons or organizations that are party to a contract that requires you to obtain this agreement, provided you executed the contract before the loss, Schedule Job Description Jobs performed for any person or organization that you have agreed with In a written contract to provide this agreement, 01998 by tho Workors' Componsatlon Insuranoa Rating Bureau of California, All rights reserved. REVIEWED BY: EUNICE HEREDIA (PG �OF(/ ) RJMDESI-01 AUSTI ,4COR0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `-� 9/7/2018 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER License IF Utb t / IOA Insurance Services 4370 La Jolla Village Drive Suite 600 San Diego, CA 92122 INSURED RJM Design Group, Inc.. 31591 Camino Capistrano San Juan Capistrano, CA 92675 All Smith ialc: rio. Ext): (619) 788-5795 50206 I (A C. No1.(619) 574-6288 1 Ali.Sm COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADEX 1%] OCCUR 1,000,000 PSB0007263 09/30/2018 09/30/2019 DAMAGE TO RENTED _.PAEMI$FS��/xcur_rencel ! $ X Cont Liab/Sev of Int 10,000 MED EXP (Any one arson _—_-_-_ PERSONAL & ADV INJURY ': $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO- LOC POLICY X 4,000,0_0 PRODUCTS –COMP/OP AGG $ _ Deductible 0 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea acccid t $ ANY AUTO X PSA0002412 0913012018 09/30/2019: BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY {Per accident).. $______---___ X pN pyy p AIR OS ONLY X AUTOS ONY OPERTY AMAGE :;_(Per aeaident X No Co. Owned Autos j --- ____;_$_------- A X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 1,000,000 -- -- EXCESS LIAB CLAIMS -MADE — —.... ..... - PSE0003628 09/30/2018 09/30/2019 AGGREGATE $ 1,000,000 DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X _ — .STATUTE._ EERH OFFICEWMEMBER EXCLUDED? ECUTIVE Y[ X PSW0004066 09/3012018 09/30/2019 1000,000 E.L. ACCIDENT $ (Mandatory in NH) NIA -_ _- E.L. DISEASE - EA EMPLOYEE 1,000,000 If yes, describe under _$ - - --- 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT : $ B Prof Liab/Clms Made PAAEP0031101 10/01/2018 10/01/2019 Per Claim 2,000,000 B Ded.: $25K Per Claim PAAEP0031101 10/01/2018 10/01/2019 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: A-2014-223-03 A-2009-023 The City of Santa Ana, its officers, employees and representatives are Additional Insureds with respect to General/Hired & Non -Owned Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation. 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. REVIEWED BY: EUNICE HEREDIA (PGt OFfl ) City of Santa Ana Attn: Susie Furjanic PO Box 1988 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Named insured: RJM Design Group, Inc. Policy Number: PSB0007263 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack°FOR DESIGN PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided. under the following: BUSINESSOWNERS. COVERAGE FORM - SECTION II — LIABILITY C. WHO IS AN INSURED is amended to include as an additional insured any person or organization that you agree in a contract or agreement requiring insurance to ihclude. as -an additional insured on this policy., but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by you or those acting on your behalf: a. In the performance of your ongoing operations; b. In oonnection with premises owned by or rented to you; or r_. In ronriahtion with "your work" and inrludpd within the "product=completed operations hazard". 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. This insurance :does not apply on any basis to any person or .organization for which coverage as an additional insured specifically is added by another endorsement to this policy. b. This insurance does not apply to the. rendering of or failure to render any "professional services". c. This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits of Insurance. 3: The rulluwirry is added to SECTION III H.2. Other Insurance -. COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION 11 — LIABILITY) However, if you specifically agree in a contract or agreement that :the insurance provided to an PPS 304 06 10 additional insured under this policy must apply on a primary basis, or a. primary and non-contributory Oasis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, Provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs after you have entered 4ilu tlidl uur:didut.ut ayr:etwierit, ui b. The "personal .and advertising injury" .for which coverage is sought arises out' of an offense committed after you. have entered Into that contract or agreement. 4. The following is added to SECTION IIi K. 2. Transfer of Fights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION II — LIABILITY) We waive any rights of recovery we may have against any person or organization beoause of payments we make for "bodily injury", "property damage" or "personal and advertising injury" arising out. of ':your worn' performed oy you, or on your behalf, under .a. contract or agreement with that person or organization. We waive these rights only where you have agreed to do so as part of a contract or agreement 'with such person or organization entered into by you before the "Bodily injury" or "property damage" occurs, or the "personal .and advertising injury" offense is committed. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN. UNCHANGED, Page 1 of.1 REVIEWED BY: EUNICE HEREDIA (PG, OF ) Named Insured: RIM Design Group, Inc. Policy Number: PSA0002412 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. Broad Form Named Insured The following is added to the SECTION II - COVERED AUTOS LIABILITY COVERAGE, Para- graph A.I. Who Is An Insured Provision: Any business entity newly acquired or formed by you during the policy period, provided you own fifty percent (50%) or more of the business entity and the business entity is not separately insured for Bus- iness Auto Coverage. Coverage is extended up to a maximum of one hundred eighty (180) days following the acquisition or formation of the business entity. This provision does not apply to any person or organization for which coverage is excluded by endorsement. B. Employees As Insureds The following is added to the SECTION II - COVERED AUTOS LIABILITY COVERAGE, Para- graph A.I. Who Is An Insured Provision: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. Blanket Additional Insured The following is added to the SECTION II - COVERED AUTOS LIABILITY COVERAGE, Para- graph A.I. Who Is An Insured Provision: Any person or organization that you are required to include as an additional insured on this coverage form in a contract or agreement that is executed by you before the "bodily injury" or "property damage" occurs is an "insured" for liability coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in SECTION II - COVERED AUTOS LIABILITY COVERAGE. The insurance provided to the additional insured will be on a primary and non-contributory basis to the additional insured's own business auto coverage if you are required to do so in a contract or agreement that is executed by you before the "bodily injury" or "property damage" occurs. D. Blanket Waiver Of Subrogation The following is added to the SECTION IV - BUSI- NESS AUTO CONDITIONS, A. Loss Conditions, S. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against any person or organization to the extent required of you by a contract executed prior to any "accident" or PPA 300 0313 "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. E. Employee Hired Autos I. The following is added to the SECTION 11 - COVERED AUTOS LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes In General Conditions: Paragraph 6.11b, of the Other insurance Con- dition in the BUSINESS AUTO CONDITIONS is deleted and replaced with the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". F. Fellow Employee Coverage SECTION II - COVERED AUTOS LIABILITY COVERAGE, Exclusion B.6. does not apply if you have workers compensation insurance in -force covering all of your employees. G. Auto Loan Lease Gap Coverage SECTION III - PHYSICAL DAMAGE COVERAGE, C. Limit Of Insurance, is amended by the addition of the following.- In ollowing:In the event of a total "loss" to a covered "auto" shown in the Schedule of Declarations, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: 1. The amount paid under the PHYSICAL DAMAGE COVERAGE section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of the "lass"; REVIEWED BY: 4L/ X ,EUNICE HEREDIA (PG OF ) Named Insured: RJM Design Group, Inc. Policy Number: PSW0004066 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization All persons or organizations that are party to a contract that requires you to obtain this agreement, provided you executed the contract before the loss. Schedule Job Description Jobs performed for any person or organization that you have agreed with in a written contract to provide this agreement. ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. REVIEWED BY: EUNICE HEREDIA (P OF(J ) v �