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18-246 Burr Plumbing and Pumping, Inc., for Various Repairs at City Facilities
CITY OF II PUBLIC WORKS CONTRACT $45,000 OR LESS CUPERTINO 1. PARTIES This public works contract ("Contract ") is made and entered into on 'D&c ~bc-v \pr 1,-,o l 3 ("Effective Date ") by and between the City of Cupertino , a municipal corporation ("City"), and Burr Plumbing and Pumping Inc , a Corporation ("Contractor") for plumbing repair for miscellaneous City of Cupertino facilities. 2. SCOPE OF WORK Contractor will perform and provide all labor , materials , equipment, supplies , transpo1iation and any other items or work necessary to perform and complete the work required for the Project ("Work "), as required in the Scope of Work , attached here and incorporated as Exhibit A , and in accordance with the terms and conditions of this Contract. 3. TIME FOR COMPLETION 3.1 Term. This Contract begins on the Effective Date and ends on June 30, 2019 ("Contract Time") unless terminated earlier as provided herein. Contractor's Work shall begin on the date shown on a written Notice to Proceed ("NTP ") and must be fully completed within the Contract Time or on the date specifically provided in the Notice to Proceed. The City Engineer will not issue a NTP until the Contract is fully executed by both parties and City has received satisfactory proof of insurance and any performance and payment bonds that may be required. 3.2 Time is of the essence for Contractor's pe1fonnance and completion of the Work. Contractor must have sufficient time , resources, and qualified staff to deliver the work on time. 3.3 Liquidated damages of$ 200.00 will be charged for each day of unexcused delay , or City may deduct the amount from Contractor's payments . Liquidated damages are based on reasonably foreseeable consequences of delay and may include intangible losses which the Pa1iies agree may be difficult to ascertain , such as loss of public confidence in City and its contractors , interference or loss of use of public facilities , and extended disruption to the public. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Work an amount that will based on actual costs but that will be capped so as not to exceed $23,980.00 ("Contract Price"), for all of Contractor's direct and indirect costs , including all labor, matet-ials , supplies , equipment, taxes , insurance , bonds and all overhead costs. 4.2 Invoices and Payments. Contractor must submit an invoice on the first day of each month , describing the Work performed during the preceding month , itemizing labor , materials, equipment and Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILITIES Public Works Contract $45,000 /Rev . May 22, 2018 Poge l of 11 any incidental costs incurred. Contractor will be paid 95% of the undisputed amounts billed within 30 days after City receives a properly submitted invoice . Any retained amounts will be included with Contractor's final payment within 60 days of City 's acceptance of the Work as complete . 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee of City. Contractor is solely responsible for the means and methods of perfonning the Work and for the persons under this employment. Contractor is not entitled to worker's compensation or any other City benefits. 5.2 Contractor's Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Work in a competent and professional maimer and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed , registered , and/or certified to perform the Work as required by law, and have procured a City Business License. Contractor shall possess a California Contractor 's License in good standing for the following classification(s):C36 , which must remain valid for the entire Contract Time. 5.4 Subcontractors. Only Contractor's employees are authorized to work under this Contract. Prior written approval from City is required for ai1y subcontractor, and the terms and conditions of this Contract will apply to any approved subcontractor. 5.5 Tools, Materials and Equipment. Contractor will supply all tools , materials and equipment required to perform the Work under this Contract. 5.6 Payment of Taxes. Contractor must pay income taxes on the money earned under this Contract. Upon City 's request, Contractor will provide proof of pay111ent and wi II indemnify City for violations pursuant to the indenmification provision of this Contract. 6. CHANGE ORDERS Amendments and change orders must be in writing and signed by City and Contractor. Contractor's request for a change order must specify the proposed changes in the Work , Contract Price, and Contract Time. Each request must include all the supporting documentation, including but not limited to plans/drawings, detailed cost estimates , and impacts on schedule and completion date. 7. ASSIGNMENTS; SUCCESSORS Contractor shall not assign, hypothecate, or transfer this Contract or any interest therein , directly or indirectly , by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Contract and subject to City approval , which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. This Contract is binding on Contractor, its heirs , successors and permitted assigns Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACIL1i5 Public Works Contract $45 ,000 /Rev . May 22, 2018 Pa ge 2 of 11 8. PUBLICITY/ SIGNS Any publicity generated by Contractor for the Project during the Contract Time , and for one year thereafter must credit City contributions to the Project. The words "City of Cupe11ino " must be displayed in all pieces of publicity , flyers , press releases, posters , brochures, interviews, public service announcements and newspaper articles. No signs may be posted or displayed on or about City property , except signage required by Jaw or this Contract, without prior written approval from the City. 9. SUBCONTRACTORS 9.1 Contractor must perform all the Work with its own forces, except that Contractor may hire qualified subcontractors to perform up to 15 % of the Work, provided that each subcontractor is required by contract to be bound by the provisions of this Contract. Contractor must provide City with written proof of compliance with this provision upon request. 9.2 City may reject any subcontractor of any tier and bar a subcontractor from performing Work on the Project, if City in its sole discretion determines that subcontractor 's Work falls short of the requirements of this Contract or constitutes grounds for rejection under Public Contract Code Section 4107 . If City rejects a subcontractor, Contractor at its own expense must perform the subcontractor's Work or hire a new subcontractor that is acceptable to City. A Notice of Completion must be recorded within 15 days after City accepts the Work if the Contract involves work by subcontractors. 10. RECORDS AND DAILY REPORTS 10.1 Contractor must maintain daily reports of the Work and submit them to City upon request and at completion of Project. The repo11s must describe the Work and specific tasks perfom1ed , the number of workers, the hours , the equipment, the weather conditions, and any circumstances affecting performance. City will have ownership of the rep011s , but Contractor will be permitted to retain copies. 10.2 If applicable, Contractor must keep a separate set of as-built drawings showing changes and updates to the Scope of Work or the original drawings as changes occur. Actual locations to scale must be identified for all major components of the Work, including mechanical, electrical and plumbing work; HV AC systems; utilities and utility connections; and any other components City determines should be included in the final drawings of the Project. Deviations from the original drawings must be shown in detail , and the location of all main runs, piping, conduit, ductwork , and drain lines must be shown by dimension and elevation. 10.3 Contractor must maintain complete and accurate accounting records of its Work, in accordance with generally accepted accounting principles , which must be available for City review and audit , kept separate from other records , and maintained for four years from the date of City 's final payment. Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILli5 Public Works Contract $45,000 /Rev . May 22, 2018 Page 3 of 11 11. INDEMNIFICATION 11.1 To the fullest extent allowed by Jaw , and except for losses caused by the sole and active negligence or willful misconduct of City perso1mel , Contractor shall indemnify , defend , and hold harmless City , its City Council , boards and conunissions , officers , officials , employees, agents, servants , volunteers and consultants ("Indemnitees"), through legal counsel acceptable to City , from and against any and all liability , damages , claims, stop notices, actions , causes of action , demands, charges, losses and expenses (including attorney fees , legal costs and expenses related to litigation and dispute resolution proceedings), of every nature arising directly or indirectly from this Contract or in any maimer relating to any of the following: (a) Breach of contract , obligations, representations or warranties; (b) Performance or nonperformance of the Work or of any obligations under the Contract by Contractor, its employees, agents , servants, subcontractors or subcontractors; (c) Payment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work performed on or off the Project Site; and ( d) Personal injury , property damage , or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors. 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-pat1y claim , in accordance with California Public Contract Code Section 9201. At City's request, Contractor will assist City in the defense of a claim , dispute or lawsuit arising out of this Contract. 11.3 Contractor's duties under this entire Section are not limited to Contract Price , Workers' Compensation or other employee benefits , or the insurance and bond coverage required in this Contract: Nothing in the Contract shall be construed to give rise to any implied right of indenmity in favor of Contractor against City or any other Indemnitee. 11.4 Contractor 's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract , a purchase order or other transaction. 12. INSURANCE Contractor shall comply with the Insurance Requirements , attached and incorporated here as Exhibit B. Contractor must provide satisfactory proof of insurance and maintain it for the Contract Time or longer as required by City. City will not execute the Contract until City has approved receipt of satisfactory certificates of insurance and endorsements evidencing the type , amount, class of operations covered , and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance at Contractor's expense, deducting the costs from Contractor's compensation, or terminating the Contract. Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILlii Public Works Contract $45,000/Rev. May 22, 2018 Page 4 of 11 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all laws and regulations applicable to this Contract. Contractor will promptly notify City of changes in th e law or other conditions that may affect the Project or Contractor's ability to perform . Contractor is responsible for verifying the employment status of employees performing the Work , as required by the Inm1igration Reform and Control Act 13.2 Labor Laws. (a) Contracts of $1 ,000 or more are subject to the requirements of the California Labor Code , including but not limited to: (i) Prevailing wage laws under Labor Code Section 1775 , which require Contractor to pay prevailing wages applicable in Santa Clara County for each craft, classification , or type of worker needed to perform the Work , including health , pension and vacation. Th e prevailing wage rates are on file with the City Engineer's office and are available online at http://www .di r.ca .gov/DLSR; (ii) Apprenticeship requirements under Labor Code Section 1777 .5 for Contacts $30 ,000 or more ; (iii) Maintain certified payroll records in accordance with Labor Code Sections 1776 and 1812 , and electronically submit them to the Labor Commissioner as required by the regulations of California, Department oflndustrial Relations ("DIR"); (iv) Comply with DIR Monitoring, Enforcement and Registration requirements of Labor Code Section 1725.5. (b) Contractor must compensate workers who are paid less than pi·evailing wages or required to work more than a legal day 's work. Contractor will also be required to pay City a penalty of $ 200.00 per worker for each day of violation. ( c) As required by Labor Code Section 1861 , by signing this Contract Contractor certifies as follows: "I am aware of Labor Code Section 3700 which requires every employer to be insured against liability for workers ' compensation or to undertake self-insurance in accordance with the provisions of that code , and I will comply with such provisions before commencing the Work on this Contract." 13.3 Discrimination Laws. Contractor shall not discriminate on the basis ofrace, religious creed , color, ancestry , national origin , etlmicity , handicap , disability , marital status , pregnancy , age , sex, gender, sexual orientation, gender ident ity , Acquired-Immune Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti-discrimination laws , including Govenunent Code Sections 12900 and 11135 , and Labor Code Sections 1735 , 1777 and 3077.5. Consistent with City policy prohibiting harassment and discrimination , Contractor understands that harassment and discrimination directed toward a job applicant , an employee, a City employee, or any other person, by Contractor or Contractor's employees or sub-contractors will not be tolerated. Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILli§ Public Works Contract $45,000 /Rev . May 22, 2018 Page 5 of 11 13.4 Conflicts of Interest. Contractor , its employees , subcontractors, servants and agents , may not have , maintain or acquire a conflict of interest in relation to this Contract in violation of law , including Government Code section I 090 and Government Code section 81000 and their accompanying regulations. No officer, official , employee , consultant, or other agent of the City ("City Representative ") may have , maintain , or acquire a "financial interest" in the Contract , as that term is defined by state law, or in violation of a City ordinance or policy while serving as a City Representative or for one year thereafter. Contractor , its employees , subcontractors , servants and agents warrant they are not employees of City or have any relationship with City officials , officers or employees that creates a conflict of interest. Contractor may be required to file a conflict of interest form if it makes certain governmental decisions or serves in a staff capacity , as defined in section 18700 of the California Code of Regulations. Contractor agrees to abide by City rules governing gifts to public officials and employees . 13.5 Remedies. Any violation of Section 13 constitutes a material breach and may result in City suspending payments , requiring reimbursement, or terminating the Contract. City reserves all rights and remedies under the law and this Contract , including seeking indemnification. 14. BONDS For contracts of $25,000 or more, Contractor must obtain a payment bond and a performance bond , each in the penal sum of 100% of the Contract Price, using the Bond Forms attached and incorporated here as Exhibit C. Each bond must be issued by a surety admitted in California, with a financial rating from A.M. Best Company of Class A-or higher , or as otherwise acceptable to City. If an issuing surety cancels a bond or becomes insolvent , Contractor must provide a substitute bond from a surety acceptable to City within seven calendar days after written notice from City. If Contractor fails to do so , City may in its sole discretion and without prior notice , purchase bonds at Contractor 's expense , deduct the cost from payments due Contractor, or terminate the Contract. City will not execute the Contract nor issue the NTP until the required bonds are submitted. 15. UTILITIES, TRENCHING AND EXCAVATION 15.1 Contractor must call the Underground Service Alert ("USA ") 811 hotline and request marking of utility locations before digging or commencing Work. For underground service alerts for street lighting and traffic signal conduits , City's Service Center must be called at (408) 777-3269. Government Code Section 4215 requires Contractor to notify City and Utility in writing if it discovers utilities or utility facilities not identified in the Contract. 15.2 Pursuant to Government Code Section 7104 , Contractor must stop work , notify City in writing , and wait for instructions if one of the conditions below is found at the worksite. City will work with Contractor to amend the Contract or issue a change order if the discovered conditions materially change the Work/Performance, Contract Time or Contract Price. (a) Material believed to be hazardous waste under Health and Safety Code Section 25117 , and which requires removal to a Class I, Class JI , or Class III disposal site pursuant to law; (b) Subsurface or latent physical conditions at the Project worksite differing from those indicated by information about the worksite made available to Contractor ; and Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILlii Public Works Contract $45,000 /Rev . May 22, 2018 Page 6 of 11 (c) Unknown physical conditions at the Project worksite of any unusual nahu-e , materially different from those ordinarily encountered and from those generally recognized as inherent in the character of the Work. 15.3 For contracts $25 ,000 or higher that require excavation or involve trenches five feet or more in depth , Contractor must submit a detailed plan for City approval , per Labor Code Section 6705 prior to commencing work. The plan must show the design of shoring , bracing, sloping and other provisions for worker protection from caving ground and other hazards. The protective system must comply with all Construction Safety Orders. If the plan varies from shoring system standards , it must be prepared by a registered civil or structural engineer. 16. URBAN RUNOFF MANAGEMENT 16.1 All Work must fully comply with federal , state and local laws and regulations concerning storm water management. Contractor must avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control , Contractor will use only the amount of water necessary to dampen the dust. Contractor will take all steps necessary to keep wash water out of the streets , gutters and storm drains. Prior to the start of the Work , Contractor will implement erosion and sediment controls to prevent pollution of storm drains , and must upgrade and maintain these controls based on weather conditions or as otherwise required by City. These controls must be in place during the entire Contract Time and must be removed at the end of construction and completion of the Work. Such controls must include, but will not be limited to , the following requirements: (a) Install storm drain inlet protection devices such as sand bag barriers, filter fabric fences, and block and gravel filters at all drain inlets impacted by construction. During the annual rainy season, October 15 through June 15 , storm drain inlets impacted by construction work must be filter-protected from onsite de-watering activities and saw-cutting activities . Shovel or vacuum saw-cutslurry and remove from the Work site; (b) Cover exposed piles of soil or construction material with plastic sheeting. Store all construction materials in containers; (c) Sweep and remove all materials from paved smfaces that drain to streets, gutters and storm drains prior to rain and at the end of each work day. When the Work is completed, wash the streets, collect and dispose of the wash water off site in lawful maimer; (d) After breaking old pavement, remove debris to avoid contact with rainfall/runoff; (e) Maintain a clean work area by removing trash, litter, and debris at the encl of each work day and when Work is completed . Clean up any leaks , drips , and other spills as they occur. 16.2 These requirements must be used in conjunction with the California Stormwater Quality Association and California Best Management Practices Municipal and Construction Handbooks, local program guidance materials from municipalities, and any other applicable documents on stormwater quality controls for construction. Contractor's failure to comply with this Section will result in the issuance of noncompliance notices, citations, Work stop orders and regulatory fines. Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILlii Public Works Contract $45,000 /Rev . May 22, 2018 Pag e 7 of 11 17. PROJECT COORDINATION City Project .Manager. City assigns Ty Bloomquist as the City representative for all purposes under this Contract, with authority to require compliance with the Scope of Work. City may substitute Project Managers at any time and without prior notice to Contractor. Contractor Pro,ject Manager. Subject to City approval , Contractor assigns Kevin Burr -------------------as its single representative for all purposes under this Contract, with the responsibility to ensure progress with the Work. Contractor's Project Manager is responsible for coordinating and scheduling the Work and must regularly update the City Project Manager about the status and any delays with the Work , consistent with the Scope of Work. Any substitutions must be approved in writing by City. 18. ABANDONMENT AND TERMINATION 18.l City may abandon or postpone the Project or parts therefor at any time. Contractor will be compensated for satisfactory Work performed through the date of abandomnent and will be given reasonable time to close out the Work. With City 's pre-approval in writing , the time spent in closing out the Work will be compensated up to 10% of the total time expended in performing the Work. 18.2 City may terminate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered through the termination date and will be given reasonable time to close out the Work. 18.3 Final payment will not be made until Contractor delivers the Work and provides records documenting the Work, products and deliverables completed. Nothing in the Section below is intended to delay , abridge or bar City's right under this Section. 19. GOVERNING LAW, VENUE AND DISPUTE RESOLUTION This Contract is governed by the laws of State of California. Venue for any legal action shall be the Superior Court of the County of Santa Clara, California . The dispute resolution procedures of Public Contract Code Section 20104 , incorporated here by reference , apply to this Contract and Contractor is required to continue the Work pending resolution of any dispute. Prior to filing a lawsuit, Contractor must comply with the claim filing requirements of the California Govenunent Code. If the Paiiies elect arbitration , the arbitrator's award must be supported by law and substantial evidence and include detailed written findings of law and fact. 20. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint , or pursues arbitration , appeal, or other proceedings to enforce its rights or a judgment in connection with this Contract, the prevailing party will be entitled to reasonable attorney fees and costs. Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FAC1Lli5 Public Works Contract $45,000 /Rev . May 22. 2018 Pag e 8 of 11 21. SIGNS/ADVERTISEMENT No signs may be displayed on or about City 's property , except signage which is required by law or by the Contract, without City 's prior written approval as to size , design and location. 22. TIDRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Contract. 23. WAIVER Neither acceptance of the Work nor payment thereof shall constitute a waiver of any contract provision. City waiver of any breach shall not constitute waiver of another pro v ision or breach. 26. WARRANTY Contractor warrants that materials and equipment used will be new, of good quality , and free from defective workmanship and materials , and that the Work will be free from material defects not intrinsic in the design or materials. All Work , materials and equipment should pass to City free of claims, liens or encumbrances. Contractor warrants the Work and materials for one year from the date of City 's acceptance of the Work as complete ("Warranty Period "), except when a longer guarantee is provided by a supplier, manufacturer or is required by this Contract. During the Warranty Period , Contractor will repair or replace any Work defects or materials , including damage that arises from Contractor's Wananty Work, except any wear and tear or damage resulting from imprope r use or maintenance . 27. ENTIRE CONTRACT This Contract and the attachments, documents , aiid statutes attached, referenced, or expressly incorporated herein, including authorized amendments or change orders constitute the final and complete contract between City and Contractor with respect to the Work and the Project. No oral contract or implied covenant will be enforceable against City. If any attachment or incorporated provisions conflict or are inconsistent with the terms of thfa Contract, the Contract terms will control. 28. SEVERABILITY/PARTIAL INVALIDITY If a court finds any term or provision of this Contract to be illegal , invalid or unenforceable, the legal portion of said provision and all other contract provisions will remain in full force and effect. 28. SURVIVAL The contract provisions which by their nature should survive the Contract or Completion of Project, including without limitation all warranties, indemnities, payment obligations , insurance and bonds , shall remain in full force and effect after the Work is completed or Contract ends. Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILli Public Works Contract $45,000 !Rev . May 22, 2018 Page 9 of 11 29. INSERTED PROVISIONS Each provision and clause required by law to be inserted in this Contract will be deemed to be included and will be infe1Ted herein. Either party may request an amendment to cure mistaken inse1tions or omissions of required provisions. 30. CAPTIONS The captions , titles, and headings in this Contract are for convenience only and may not be used in the construction or interpretation of the Contract or for any other purpose. 31. COUNTERPARTS This Contract may be executed in counterparts , each of which is an original and all of which taken together shall form one single document. 20. NOTICES All notices, requests, and approvals must be sent in writing to the persons below and will be considered effective on the date of personal delivery , the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino: 10300 Torre Avenue , Cupertino CA 95014 Attention: Ty Bloomquist Copy to: Carl Valdez Email: tyb(a1cupe1tino.org 30. VALIDITY OF CONTRACT To Contractor: Burr Plumbing and pumping Inc Attention: Kevin Burr Copy to: Email: Burr(mbp2inc.com This Contract is valid and enforceable only if (a) it complies with the purchasing and contract provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, (b) is signed by the City Manager or an authorized designee, and (c) is approved for form by the City Attorney's Office. 32. EXECUTION The persons signing below warrant they have the authority to enter into this Contract and to legally bind their respective Parties. If Contractor is a corporation, signatures from two officers of the corporation are required pursuant to California Corporations Code Section 313. Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILla Public Works Contract $45,000 /Rev. May 2Z 2018 Page IOofll IN WITNESS WHEREOF , the parties have caused this Contract to be executed as of the Execution Date first above written. CONTRACTOR Burr Plumbing and Pumping I CITY OF CUPERTINO, a Municipal Corporation Title: Owner Signature Date: _,/'--2-=+--'1_6--'-/J ...... '/_8 ____ _ APPROVED AS TO FORM: By: V. FIERRO Cupertino City Attorney ATTEST: By: Title: Director of Public Works Signature Date: ----------- ( Public Works Project PLUMBING REPAIRS for MISCELLANEOUS CITY of CUPERTINO FACILlii Public Works Contract $45,000 /Rev . May 22, 2018 Page 11 of 11 Burr Plumbing and Pumping Inc. Plumbing Repair for Misc. Cupertino Facilities Proposal Amount $ Description miscellaneous plumbing repair Account# Proposal Amount Description Account# Proposal Amount Description Account# Unforeseeables/Extras SUBTOTAL Contingency CONTRACT TOTAL PW Supervisor $ $ $ 23,000.00 23,000 .00 980.00 23,980.00 Ken Tanase I -3· 17 Date PROPOSAL & PUMPING INC.' I No. 9740 1645 Almaden Rd . San Jose . CA 95125 * Tel (408) 287 -2877 * Fax (408) 287-2844 License#730349 A. C36. D21 Proposal submitted to : City of Cupertino Date Submitted : 11-11-18 Description: General Plumbing Upgrades & Repairs Phone Number: 408 -655-9624 Job Name : Street: 10555 Mary Ave . Job Location: At Customer's Direction City , State , ZIP : Cupertino , CA 95014 Job Phone : Fax Number: Cell Phone : E-Mail: tvb@citvofcuoertino .ora Contact: Ty Bloomquist We hereby submit specifications and estimates to perform gene ral plumbing repairs and upgrades as directed by City of Cupertino staff. Scope of Work: 1. Perform general plumbing repairs and upgrades as directed by City of Cupertino staff. All work to be performed during regular, overlime or double time work hours as required by the DIR for the classification of work performed. Regular Time : $180. 00 per hour. Overlime : $270. 00 per hour Double Time : $320. 00 per hour. Exclusions : 1. All engineering , soil t esting and surveying . 2 . All permits , drawings or related fees, as required , will be additional. 3 . Repair of any unmarked lines , including ; PG&E, water, cable , telephone, fiber optic, irrigation, etc. 4 . Any and all required bonds or posting of certificates of deposits required . 5 . Wall, ceiling, flooring, framing and surface finish repai rs . 6 . Responsibility for any existing or other systems and work not directly related to our work 7 . Responsibility fo r any electrical, plumbing, drains , fire sprinkler and/or controls not expre ssly included in this proposal. 8 . Any changes or deviations from th is proposal will be executed only on writt e n order and will become an extra charge over the cost of this proposal. 9. Any unknown or unfo re seen circumstances . 1 I P age Burr Plumbing & Pumping , Inc. Initial ---- II /., 11 PROPOSAL & PUMJ:IING INC. I No. 9740 1645 Almaden Rd. San Jose, CA 95125 * Tel (408) 287-2877 * Fax (408) 287-2844 License#730349 A. C36. D21 We Propose to hereby furnish material and labor -in accordance with above specifications For the sum of: (NTE) Twenty Three Thousand Dollars ($23 ,000 .00) NTE Payment to be made as follows: Payment due upon completion of scope of work Burr Plumbing & Pumping, Inc. Note : Proposal may be withdrawn if not accepted within 30 days . The person signing below represents that he or she is authorized by the Owner to accept this proposal on behalf of the Owner listed above, and further represents that he or she has read, understood and agreed to the terms and conditions set forth on the last page of this Proposal. STATE LAW REQUIRES ANYONE WHO CONTRACTS TO DO CONSTRUCTION WORK TO BE LICENSED BY THE CONTRACTORS' STATE LICENSE BOARD IN THE LICENSE CATEGORY IN WHICH THE CONTRACTOR IS GOING TO BE WORKING--IF THE TOTAL PRICE OF THE JOB IS $500 OR MORE (INCLUDING LABOR AND MATERIALS). LICENSED CONTRACTORS ARE REGULATED BY LAWS DESIGNED TO PROTECT THE PUBLIC . IF YOU CONTRACT WITH SOMEONE WHO DOES NOT HAVE A LICENSE, THE CONTRACTORS' STATE LICENSE BOARD MAY BE UNABLE TO ASSIST YOU WITH A COMPLAINT . YOUR ONLY REMEDY AGAINST AN UNLICENSED CONTRACTOR MAY BE IN CIVIL COURT , AND YOU MAY BE LIABLE FOR DAMAGES ARISING OUT OF ANY INJURIES TO THE CONTRACTOR OR HIS EMPLOYEES . YOU MAY CONTACT THE CONTRACTORS' STATE LICENSE BOARD TO FIND OUT IF THIS CONTRACTOR HAS A VALID LICENSE . THE BOARD HAS COMPLETE INFORMATION ON THE HISTORY OF LICENSED CONTRACTORS, INCLUDING ANY POSSIBLE SUSPENS IONS , REVOCATIONS, JUDGMENTS , AND CITATIONS . THE BOARD HAS OFFICES THROUGHOUT CALIFORNIA. PLEASE CHECK THE GOVERNMENT PAGES OF THE WHITE PAGES FOR THE OFFICE NEAREST YOU OR CALL 1-800-321 -CSLB FOR MORE INFORMATION . The services to be provided by Bu r r Plumbing & Pumping, Inc . DO NOT include any engineering work, and the customer is responsible for providing all engineer ing determinations . Acceptance of Proposal -The above prices, specifications and conditions are satisfactory and are hereby accepted. Burr Plumbing & Pumping, Inc. is authorized to do the work as specified. Payment will be made as outlined above. l !<IA l q Date of Ace ~ ~; _ __._. ----- Signature~,.a.-u ~·-+-~~)-----Company rn~ J~,~~10 21 Page Burr Plumbing & Pumping , Inc. Initi a l ---- fl PROPOSAL & PUMPING INC. No. 9740 1645 Almaden Rd. San Jose. CA 95125 * Tel (408) 287-2877 * Fax (408) 287-2844 License#730349 A. C36, 021 Conditions of Proposal 1. Allowing Burr Plumbing & Pumping, Inc. ("Burr") to commence work or preparation for work constitutes acceptance by you of this Proposal and all its terms and conditions . Quotations herein , unless otherwise stated, are for immediate acceptance and are subject to change. 2. BURR shall be paid monthly progress payments, or as outlined in this proposal. if progress payments are provided in this proposal, on or before the 10 1h day of each month for the value of the work completed plus the value of materials and equipment suitably stored less the aggregate of previous payments made to BURR. Final payment shall be made within 30 days of substantial completion of the work described in this proposal. Payment for goods is due on delivery of the goods to the project site . 3. Back charges shall not be considered valid unless contained in a writing signed by BURR before the work is executed . 4. All sums not paid when due shall bear interest at the rate of 11/:z% per month from the due date until paid or the maximum legal rate permitted , whichever is less; all costs of collection, including the actual attorney's fees and costs incurred by BURR, the actual expert fees incurred by BURR and costs as defined by the California Code of Civil Procedure shall be paid by Owner or its representatives . 5. If Owner or its representative fail to make a payment to BURR as provided herein , BURR may stop work without prejud ice to any other remedy it may have . 6. Owner or its representative is to prepare all work areas to accept the work of BURR under the contract . BURR will not be called upon to start work until sufficient areas are ready to insure that BURR may continue to work until completed . 7. After acceptance of this Proposal, BURR shall be given a reasonable time in which to make delivery of materials , equipment and labor and to complete its work under this Proposal . BURR shall not be liable for delays or defaults where occasioned by any causes of any kind and extent beyond its control, including but not limited to delays caused by the owner , general contractor, architect and/or engineers, armed conflict , acts of terrorism or economic dislocation resulting therefrom, ·embargos , shortages of labor, equipment or materials, production facilities delays or transportation-delays , labor difficulties , civil disorder of any kind , the actions of civil or military authorities , vendor priorities and allocations, fires , floods , accidents and acts of God . 8. All workmanship is guaranteed against defects in workmanship for a period of one year from the date of installation . This warranty is in lieu of all other warranties , express or implied, including any warranties of merchantability or fitness for a particular purpose. BURR will not be responsible for special, incidental or consequential damages and shall not be responsible for damage to its work occasioned by other parties. Any repair work necessitated by damage caused by others directed by the Owner or its representatives to be performed will be considered extra work. BURR's responsibility for damage or loss in transit ceases upon delivery in good condition to a public carrier. 9. Work called for herein is to be performed during BURR's regular working hours . Overtime rates will be charged for all work performed outside such hours as an extra cost to Owner or its representative . 10 . All materials shall be furnished in accordance with the respective industry tolerances for variation in c~lor, thickness , and size , finish , texture and performance standards . 11 . Notwithstanding any provision contained in this Proposal or the contract documents between Owner and General Contractor, BURR may file a mechanic's lien . stop notice, payment bond claim or other claim on its own behalf in the event that any payment due to BURR is not made as and when prov ided for in the terms of this Proposal. 12 . The subcontract form used between BURR and Owner's General Contractor will be the A401 subcontract, then current, as published by the American Arbitration Association . Where there is a conflict between the terms of that subcontract form and this Proposal , or when the contract documents between Owner and its General Contractor conflict with the terms of this Proposal, then this Proposal shall govern . 13 . Owner or its representative shall furnish all temporary site facilities , including suitable covered storage facilit ies and hoisting as requ ired at no cost to BURR . 14 . Owner and its representative, including its General Contractor, shall make no demand for liquidated or delay damages in any sum which may exceed any such sum specifically provided for in th is Proposal , and no liquidated damages may be assessed aga inst BURR for delays or causes attributable to other contractors or arising outside the scope of this Proposal. 15 . Owner or its representative, including Owner's General Contractor, shall purchase and maintain property insurance upon the fu ll value of the entire work and/or materials to be supplied which shall include the interest of BURR. Owner or its rep resentative , including Owner's General Contractor shall furnish to BURR evidence that it has named BURR as an additional insured on said policy of insurance in an amount of no le ss than $1 million . 31 P a g e Burr P l umbing & Pump ing, Inc. Ini t ial ----- Cn nlrnc t0r sha ll proi.:ur e anu mai ntai n for the <l urnlion ol'lhe i.:on lr m:t, andfor flve ywrs.fullowing tin: co mpletion of /he Prujecl , ins urauce against claims for inj ur ies to persons or damages Lo pro perty whic h may arise from or in connect ion with the pcrfor mam::c of" the work hereunder by Contractor, its agents, rep resentat ives, emp loyees or suhcon tmc to rs. I\HNlMlfM SCOPE, AND UMIT OI•' INSlll~ANCl~ Coverage sha ll be a l Jeas l as broa d ,1.s: 0 Co111ntercia l General Liabi litJ (CGL}: lns umnce Serv ices Orlice (I SO) For 111 CG 0 0 0 1 cove ring CG!. on an ·•occ urrence" basis, wril/en on a comprehensive general liabili ty form, and mus/ indude C(We r age fur liability a l'i siflR .limn Con/racJor 's o r Subcontractor's acts ur om issions. i11clutfing Contractor's p rotected coverage, 1,/ankct co11trac t11al. pro ducts und comp leted operations, ve h icle cove 1·age and e mployer·.,· 1wn-nw 11 ership liahility cov 1!r uge, with limit s of at leas/ $2,()()0,(HJO per occt1rre1/i:e. T/1e (.'(,L policy must protect again.~/ any and ail /iabili1yfor per.wm ol irr/111 :v. dealh. property da mage or des tru cti on, and perso na l nnd ndve ,tising inj ury. I rn genernl a,.-1.,gg re ute li m i l appli es, e it her t he genern l aggregate I im it shall a pply sepnrntely to Lh is project/location (I SO CG 25 03 or 25 04) or the general aggrega te lim it sha ll be twice th e rc~uircd occurrence limi t. u. It sha ll be a requ ire ment un der th is agrel:!me nt that any avai lable insura nce proceeds broader tha n or in excess of the s pec ified 1n i11 imu111 ins urn nce coverage re q uireme nts and /or li mits sha ll he made ava ilab le Lo the /\cl<li t ional Jnsme cl uncl slrn ll be (I ) t he m i nimum cov~ragc/lim it1> spc"i licd in this a.grcc rn cnt; or (2) the broader coveruge and max im um limits o r cov'rngc orany insunmce poli ·y , whic hever is !,'rca lcl'. b. Ad di tio nal Ins ur ed co vernge under Con tractor 's po licy shall be "pr imary an d non-co ntr ib utory," will not seek co ntr ibution from C ity's insurance/se lf-ins urance, an d shall be at leas t as broad us ISO CO 20 0 I 04 13 The limir s of insu rance requi red may be sat is(ic<l by a combin ntion of pri mary anc..l umbrel la or excess ins ura nce, prnv i<k d c,l"l1 po lic y c.;o mp l il:!s with the re q uiremen t s se t fol'lb in thi s Co ntrac t. Any umbre ll a or e, ·cess insu ru nce slw ll con tain or be en do rsed to co ntai n ri prov is ion t hat such co verage sha ll a lso ap ply on a pf inrnry untf r1on-c o11 tr ibutory bas is for the benefi t of'C ily before the City's ow n insumn ce or self-in suran ce sh a l l bi.: cul led upo n Lo prol cc l C ity ,1s a named insured. Automobile Liability: !SO Fo rm CA 00 0 I cove ring a ny a ulo (Code I), or ifC011trac tor ha::; no ownctl autcs, then hi red autos' (Cod e 8) mid non-aw ned autos (Code 9), wit h li m il no k s:, lhan Sl,000,000 pt:r a1:c iden l fo r bod ily inj ury a nd prope rly da.m a)c . \Vorkcn;' Compl\nsalion: As re quired by th e Sta te of Ca liforn ia, with S tat utory Limi1s, an<l l~mployer's Li ubi I ity Insu ra nce q i' no les s tlinn $1,000,000 per acciden t for bo di ly inju ry or d iscn&.-!, o r as otherw ise re quircu by stat ute. If Con trac tor is sel f-insured, Co ntrnctor must prov ide a Ce rti fi cat e of Pen n iss ion to Se !Ffos urc , du ly author ize d by t he DIR. [l N/A if box chec ked ( C:nmmc tor rwn~·ides wrill,!n verificat ion ii ha) 110 emp loyees). 4. Pl'ofessioual Liability wi lh li mits no less than$ l ,000 ,000 per occ ur rence or claim, a ncl $2,000,0 00 aggregate. ~ NI A i f box chec ked (Con tract is !]QJ. design/llllil d). 5. Builder's Risk . Cou rse or Com lruct ion inst 1rn ncc uti li zing an "All Ris k" (Specitil Perils) coverage form, w ith limits eq u{I I to the compl e ted va lue o f th e project a nd 110 co insurance pena lty provis ions. ,li<j_ N/ A it' box checked (Pmj ect dnes 1101 invo l w cons/me/ion or impro1•e111e111.v'i11sluliolic 111s lo prvpe rtv). /nsrmmce ll1Hfllire111i·ms for ('o,rstr11ctin11 ('011/racts -$-15, 0()0 J 'ersiim: ,\'cJl' 1017 6. Coutrm:lon,' Pollution Legal Liability and/or Asbestos Lega l Lia bility and /or Errors and Omis s ion ~ with limits 110 le~s tha n $1,0 00,000 pe r occurrence or cla im, and $2,00U,fll>O po li cy aggregate. ~ NI A if box checked (Project doeJ 1101 invo!t•e em•iromnenral liazaJ'(./.\'). 1r conlrn ctor mu i11 111ins bro ader coverage and /or hi gher li mi ts tlm n th e mi ni mum s shown above, City requ ires und shall be e nt it le d tu th e bro ader coverage an<.1/or higher li mi ts main1ained by th e co ntrac tor. Any ava ilab le insurance proceeds in excess of the specified mini mum li mit s of insurance nn d coverage shall he available to the City. Selj:fmmretl Retenlio11s. Self-in sured retentions 111 ust be dec lared ro and app rov ed by City. t\1 Cit y 's opt ion, eit her: (I) Con tractor sha ll ca us~ the in sur er to reduce or e lim inate se lf-in sur ed rete ntio ns as respects City, its officers, oftic inls, employees, an d vol unt eers; or (2) Contractor shall prov ide a fi mwc iaJ guara ntee sa tisfactory to City guaranteeing pay ment of lnsses and relate d invcst igH1 ions, c la im adminbtrntion, und defens e expense s" T he rml icy langua ge s ha ll prov ide , or be en dors ed lo provide, that the sc If-ins ured ret en ti on may be sa tisfied by eithe r th e na med in su red or tt1e C i ty. OTHER INSURANCl.i: l'ROVISIONS The insurance po li c ies .tre Lo co nti1 in, or be endorsed to conta in , the foll ow in g provis ions: ~dditional Imml'ed Sl11t11 .'i . / Th e Ci Ly o.(C upertino, its Ci ty Co un c il , officers, offic ia ls, emp loyees, agents, servnnts and volunteers are to be covl:rcd V us additio nal insUl"cds on tile CGL policy wi rh n:sJ eel w l ial:i l l i ly ,ir is ing out of the Sc rv ici::s pe rfo rmed by or on behalf of Con lraclor in c luding mat erials, parts, or eq u ipm ent fumis hcd. Endorse ment of COL coverage shal l be at least as broad as ISO FMm CG 20 IO 11 85 ur if not availab le , th rough th e addi t ion of botli CG 20 l 0, CG 20 26, CG 20 33 , or CG 2 () 3 8; and CU 20 37 ifa lat er ecLi tion is used . Pr im nt}' Co vernge Fo 1· nny cla im s re lated to thi s (lroject, Co ntractor's insura nce coverage sha ll be "primnry aud 11011 -co11tribut or.r" and at least as !>road as (SO CG 20 0 I 04 13 with respect to C ity, its officer.;, offi cia ls . 1:-mpluyccs 11 ml vul un tcc rs, .a nd sha ll nuL seek co ntr ibut ion from C ity's insu ranc e. 1f the lirnit.s of in suran ce are sut isfi ed in part by Umbrella/Excess Insurance. !he Um brclla/Exccss lnsu ram;e sha ll co nta in or be endorsed to co ntain a 11m vis ion th at such coverage shal l also app ly on a "pr ima ry and non-cont r ibutory" bas is for the benefit or City. ,IVotice of Ctmce llatirm Each in s urnnc~ pol icy requ ired sha ll pro vid e that coverngc nha l I 1)l)t be i.:ancelcd , exec pl with not ice lo th e C ity . Each cc rri fic atc of in surn ncc must s tate t hat the coverage afforded by the pol icy is in force ::i nd w ill not be red uc ed, cancelled or u I lowi;d to c.xp irc w illi oul al k ast 30 uays advance written noti ce to City, unless due to r1011 ·pay ment: of premi ums, in whic h case ten clays advance wr itt en no tice must be prov ided to City . Suc h uot ic1: mus t be sen t 10 C ity via cert ifi ed ma il and addressed to t he atti::nt ion of the C ity Manager. Builder's Risi, Contractor may subm it Builder's Risk insu1·ani::c in Lhe for m of Course of Construct io n coverage, whic h shal l name th e City ns n los1; pnyec, as i Ls inte rest may appl:ar. The Builder's Ri:;k po licy must be iss ued on an occurre nce basis, for all-r isk coverage o n n I 00 % co111 1l lete d value basis on the in surnblt; portio n of Lh c Project, with no co in surnnee pen a lr.ics. and for the bc 11 cfi t o f Cll y . lf ch e Project does nol invu lve new or major reco nstruct i01 1, C ity may elect, acting in its sole disc ret ion, to acc e pt an lnstn llntion Floater policy instead of Bui lder's Risk. For suc h projects, th e Prope 11y lnsla I lat ion Floater s lu1 11 inc l ud c i 111prove111cnt , rcmodt:1, modification, n !tern! ion , co nv e rs io n or adju stment to ex isling building s, structures, processes, mac hi nery and el111ip 111en t, and shall prov id e 11r opc rly damage covcrnge for an y bui !di ng, struc tu re, mac hi ne ry or eq uipm ent damaged, impai red, broken , or dcslroycd dur ing the pcrfo1111ance of the \Vor k, in c ludin g during 1rnnsir, insta ll at io n, 11nd tc .'>ling at the City 's si te. /11.rnrancf! Re1111ire.111enl.\'for Co11slrncfio11 Co11tmc1.1 -S./5 ,0nD Va sio11 : Nov 2017 2 ·-------------------------------------------- Waiver <?f'S11bror:ati011 Each requ ire d po licy mus t ind ude an emJor se menl provi din g that the carrie r agr ees to waive any right of subroga tion ii may have aga ins t City. Co ntractor agrees to wa ive ri ghts of su brogat io n whic h any in su rer of Contractor may acq ui re fr om Con trac tor by virtue of lhe paymen t o r a11y loss . Con trn ·tor ag rees to obtii in any cndorse mcnl that nwy he necessary to .ilfo c l th is wa iver uf su bro ga tion . The \.Vorkcrs· Co mpensation po licy sha ll be cnuorscd wi th a wa iver of sub ro gat ion i n favo 1· of the C ity fo r a ll work performed by th e Contrac tor , its emp loyee s, agent-; and su bcontrac tors. Acceptability r?f Insurers ln s urn nco mus t be issued by insurers acceptab le to City and license d to do bu s ine ss in the State of Ca lifornia, 1111<[ euch insu re r musj ha vc an A .M. l1 est'1, fi nanc ial strcn g1h rn ting of" i\" or bet Li.:r 1lild f.l Ii 11a ncial si:r.c rat ing of "V I I" or better . Verifieut/011 of Coverage Contracto r sh nll r-li rnish the C it-; with or ig ina l certifica tes nnd amcnda tory endorscrncn t8, or copies of the arrli cabk ins urance language, e ffect ing coverage req ui re d by thi s con tract. All ce rti fic ntes and end orsements are to be received a11d approved hy the City before wo rk commences. The City reserv es the r ight to require complete, cert ified copies of nil re q uired insurance pol ic ies, including end orse ments, required by thes e s pcc i f·icat io ns, at any tim e . Su bc.,m tractor.\· Con lrnc tor shal l requ ire and ver ify that all subcon tn1cto rs ma intain in sura nce 1m:ct ing all the requ ire ments sta ted herei n, an d Con lraclo r sh al l ensure th at C ity is an addit ional ins ure d on insura nce required from subconlmclors. for CC. I . coverage su bcon tractors s hall provid e coverage with a form at least as broad as CU 20 38 04 13. Sure(v Bo11rl.~ As re qui red by Contruc l and dcs1;r ib cd in Ill e Conlrnc t Doc uments . The Pay men t and Pe rfo nmmc e Bonds sha ll be in a sum equa I to the Co ntract Price . If th e Performance Elond prov ides fo r a one ~year warranty a separate Ma intenanc e 8{1ml is no t nece ss a 1y. 1 !'the warranty perio d spec ified in the Contract is fo r longer than on e year a Mai ntenance Bo nd equa l to 10% o f !he Contract Pri ce is req uired. Bonlls sha ll be duly exec ute<l by a respo nsi ble corporate surety, au thorized to iss ue suc h bo nd s in th e Stale of Ca li fo rni a and se cure d throug b an authori ze d age nt wit h an otlice in Ca li fornia. Special Ri.~ks or Circum:,tance .'i City reserves die right to mo<lif}' these req L11 remen ts , ba sed on th e natu re of the r isk, pri or experie nce, insurer, covcrngt:, nr other L:irc umsrnncc s. /11 s11 1·a1 1c,: Nequi1 ·i!11 1e11tsfhr Cm1.1·1ru ,·1inn C rmlra ct.v • $45,1/f/() Ve r si()11 · Nrw J./J/7 BURRP-1 OP ID : LM ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 12/14/2018 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(i es) must be endorsed . If SUBROGATION IS WAIVED, subject to the terms and cond itions 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 ~~~?cT Lisa Malvido Bozzuto & Associates Insurance rigNNEo Ext\: 800-989-8712 J rM Nol: 408-429-8460 34 S . Second St Campbell, CA 95008 !o'i~~ss: Lisam@dbinsurance.com Linda Ellis INSURER(S ) AFFORDI NG COVERAGE NAIC# INSURER A: Ohi o Casualty In su rance Co 24074 INSURED Burr Plumbing and Pumping, Inc INS URER B : West American In sura nce Compan 44393 1645 Almaden Rd INSURE R c : American Fire and Casualty Com 24066 San Jose, CA 95125 INSURER D: Oak Ri ver In surance Company 34630 INS URER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH IS IS T O CER TIFY THAT TH E POLIC IE S O F IN SURANCE LI STED BE LOW HAVE BEEN ISSUED TO THE INSUR ED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON DITI ON OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECT TO W HI C H THIS CERTIFI CATE MAY BE ISS UED OR MAY PERTAIN , THE IN SURANCE AFFOR DED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL L THE TERMS , EXCLUSIONS AND CONDITION S OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . INSR ADDL SUBK POLIC Y EFF POLIC Y EXP LTR TY PE OF INSURANCE ···~~ un,n POLIC Y NUMBER IMM/DD /YYYY I IMM/DD /YYYY\ LIMITS A X COMMERCIAL GE NERAL LIABILITY EACH OCCURREN CE $ l/1,000 ,000 f--D CLAIMS-M ADE 0 OC CUR BK056113743 / /UAMAi..;t: ',Y, Rt:N I t:U X X 08/31/2018 08/31/2019 1 PR EMISES Ea occurrence\ $ 500,000 '' MED EXP (Any on e person ) $ 5 ,000 f--·, _, PERSON AL & ADV INJUR Y $ 1,000,000 ~ GEN'L AGGRE GATE LIM IT APPLIES PER: GENERAL AGGREGATE $ v2,000,000 Fl 0 PRO -D LOC PRODUCTS -COMP /OP AGG $ ~2,000,000 t POLICY JE CT OTHER : Emp Ben. 1 $ 1,000,000 AUTOMOBILE LIABILIT Y COMB IN ED SINGLE LIM IT $ ./.f ,000,000 /Ea accidenll B x ANY AU TO X X BAW56267717 08/31/2018 08/31/2019 1 "BOD ILY IN JURY (Per pers on) $ f--AL L OWNED -SCHEDULED AUTO S AUTOS BODILY INJURY (Per acci dent ) $ j f---NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per acc id ent) $ f--- $/ X UMBRELLA LIAB M OCCUR EACH OCCURRENCE ' 5,000 ,000 ) f-- 08/31/201 g, ! C EXC ESS LIAB CLAI MS-MA DE ESA56113743 08/31/2018 AGGREG ATE 5 ,000,00C DED I I RETENTION$ $' ./ WORKERS COMPENSATION X I ~~~TUTE I I OTH ---AND EMPLO YERS' LIABILIT Y BUWC916059 / ER Y/N V E.L. EA CH AC CIDENT ,/'1,000 ,ooc D ANY PROPRIE TO R/PAR TNER/E XECUT IV E D X 09/01/2018 09/01 /2019-$ OFFI CER /MEMBER EXCLUDED ? N/A (Mandatory in NH) E. L. DISEASE -EA EMPLOYEE $ 1,000 ,000 If yes, describe under DES CRIPT ION OF OPERATIONS belo w E.L. DISEASE -POLI CY LIMIT $ 1,000,000 A Pollution 7930042640002 08/31/2018 08/31/2019'. Liability 2,000,000 A Property BK056113743 08/31/2018 08/31/2019' VBPP 50 ,000 DESCRIPTIO N OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Sched ul e, may be atta ched If more space is required) v RE: Various Locations Throughout Cupertino City of Cupertino, its City Council, board and commissions, officers, employees and volunteers are named as additional insured per attached endorsements. Insurance is primary and non-contributory . Waiver of Subrogation applies to the General Liability, Auto Liability <Cont'd> CERTIFICATE HOLDER CANCELLATION CITYCUP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertino THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS . Attn: Chris Mertens 10555 Mary Ave. AUTHOR IZED REPRESENTATIVE Cupertino, CA 95014 ~ I © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE INSURED'S NAME CITYCUP Burr Plumbing and Pumping, Inc BURRP-1 OP ID: LM and Workers Compensation policies. All corresponding endorsements attached. Date PAGE 2 12/14/2018 COMMERCIAL GENERAL LIABILITY CG88100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT PAGE NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY-ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS-COVERAGES A AND B 3 ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY -ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED-INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN INSURED-6 FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU © 201 3 Liberty Mutual Insurance CG 88 10 0413 Includes copyrighted material of Insurance Services Office , Inc ., with its permission . Page 1 of 8 With respect to coverage afforded by this endorsement , the provis ions of the policy apply unless modified by the endorsement. A. NON-OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I -Coverage A -Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured ; 2. It is hired , chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate , issued by the duly constituted authority of the United States of America or Canada , designating her or him a commercial or airline pilot ; and 4. It is not being used to carry persons or property for a charge . However , the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance , whether primary , excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision . B. NON-OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section 1-Coverage A-Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following : This exclusion does not apply to : (2) A watercraft you do not own that is : (a) Less than 52 feet long ; and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY-ELEVATORS 1. Under Paragraph 2. Exclusions of Section I -Coverage A -Bodily Injury And Property Damage Liability, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage " results from the use of elevators . For the purpose of this provision , elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV -Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance , whether primary , excess , contingent or on any other basis . D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part : 1. Under Paragraph 2. Exclusions of Section I -Coverage A -Bodily Injury and Property Damage Liability: CG 88 10 0413 a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the following : Paragraphs (1 ), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke , or leakage from an automatic fire protection system) to : (i) Premises rented to you for a period of 7 or fewer consecutive days; or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1 ), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as desc ribed in Section Ill -Limits of Insurance . © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc., with its permission . Page 2 of 8 b. The last paragraph of subsection 2. Exclusions is replaced by the following : Exclusions c. through n. do not apply to damage by fire , lightning , ex plosion , smoke or leakage from automatic fire protection systems to premises wh ile rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section Ill -Limits Of Insurance. 2. Paragraph 6. under Section Ill -Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above , the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to : a. Any one premise : (1) While rented to you ; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning , explosion , smoke or leakage from automatic protection systems ; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) -Paragraph 9.a. of Definitions is replaced with the following : 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion , smoke , or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner , or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract". E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded , the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I -Coverage C -Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident ; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS-COVERAGES A AND B 1. Under Supplementary Payments -Coverages A and B, Paragraph 1.b. is replaced by the following : b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d . is replaced by the following : d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work . G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II -Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by : CG88100413 a. Your acts or omissions , or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage " occurs , or the "personal and advertising injury" is committed , subsequent to the signing of such written contract or written agreement ; or © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc., with its permission . Page 3 of 8 b. Premises or facilities rented by you or used by you ; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization ; or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the follow ing additional provisions : (1) This insurance does not apply to "bodily injury", "property damage ", or "personal and advertising injury " arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or "property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own , rent , or control but only with respect to the following hazards: a) The existence, maintenance , repair , construction, erection , or removal of advertising signs, awnings , canopies , cellar entrances, coal holes , driveways, manholes, marquees, hoist away openings , sidewalk vaults, street banners, or decorations and similar exposures ; or (b) The construction , erection , or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance . However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law ; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to Paragraph 1.a. above, a person 's or organization's status as an additional insured under this endorsement ends when : (1) All work, including materials, parts or equipment furnished in connection with such work , on the project (other than service , maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed ; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph 1.b. above , a person 's or organization 's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends . With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV -Commercial General Liability Conditions. © 2013 Liberty Mutual Insurance CG 8810 0413 Includes copyrighted material of Insurance Services Office , Inc ., with its permission . Page 4 of 8 2. With respect to the insurance provided by this endorsement , the following are added to Paragraph 2. Exclusions under Section I -Coverage A -Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury " or "property damage " arising from the sole negligence of the additional insured . b. "Bodily injury " or "property damage " that occurs prior to you commenc ing operations at the location where such "bodily injury " or "property damage " occurs. c. "Bodily injury", "property damage" or "personal and advertising injury" a rising out of the render ing 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 (2) Supervisory , inspection , architectural or engineering activit ies. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision , hiring , employment , training or monitoring of others by that insured , if the "occurrence " which caused the "bodily injury " or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render , any professional architectural , engineering or surveying services. d. "Bodily inj ury" or "property damage" occurring after: (1) All work , including materials , parts or equipment furnished in connection with such work, on the project (othe r than service , maintenance or repairs) to be performed by or on behalf of the add itional insured(s) at the location of the covered ope rat ions has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured fo r ongoing operations by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and made a part of this policy . 3. With respect to the insurance afforded to these additional insureds , the following is added to Section Ill - Limits Of Insurance: If coverage provided to the additional insured is required by a cont ract or agreement, the most we w ill pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations ; whichever is less . This endorsement shall no t increase the applicable Limits of Insurance shown in the Declarations . H. PRIMARY AND NON -CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this pol icy. Condition 4. Other Insurance of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows : CG 88 10 0413 a. The follow ing is added to Paragraph a. Primary Insurance: If an additional insured 's policy has an Other Insurance provision making its policy excess , and you have ag reed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis , this po li cy shall be primary and we will not seek contribution from the additional insured 's policy for damages we cover. © 201 3 Liberty Mutual Insurance Includes cop y righted material of Insuran ce Servi ces Office , In c., with its permi ssion . Page 5 of 8 b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement , other than a premises lease , facilities rental contract or agreement , an equipment rental or lease contract or agreement , or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory , this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary , excess , contingent or on any other basis for which the additional insured has been added as an additional insured on other policies . I. ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under th is policy . 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notjce of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured . 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section Ill -Limits of Insurance of this policy , whichever are less . These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS/ MALPRACTICE WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II -Who Is An Insured is replaced with the following : (1) "Bodily injury" or "personal and advertising injury": CG 88 10 0413 (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limfted liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child , parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1) (a) above ; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services . However, if you are not in the business of providing professional health care services or providing professional health care personnel to others, or if coverage for providing professional health care services is not otherwise excluded by separate endorsement , this provision (Paragraph (d)) does not apply. © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc., with its permission . Page 6 of 8 Paragraphs (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you , includes the direct supervision of other "employees" of yours . However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury ", or caused in whole or in part by their intoxication by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section II -Who Is An Insured is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization . However: a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you ; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; an9 c. Coverage 8 does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV -Commercial General Liability Conditions, the following is added to Condition 6. Representations: Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV -Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an "occurrence", offense , claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section II -Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses , claims or "suits" shall have received such notice from the agent, servant or "employee". N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. 0. BODILY INJURY REDEFINED Under Section V -Definitions, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness or disease sustained by a person . This includes mental anguish , mental injury, shock, fright or death that results from such physical injury , sickness or disease. © 2013 Liberty Mutual Insurance CG88100413 Includes copyrighted material of Insurance Services Office , Inc., with its permission. Page 7 of 8 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following : a. Expected Or Intended Injury "Bodily injury" or "property damage" ex pected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage " resulting from the use of reasonable force to protect persons or property . Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV -Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard" provided : 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization ; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement. © 201 3 Liberty Mutual Insurance CG 88 10 0413 Includes copyrighted material of Insuran ce Services Office , Inc., with its pe rmission . Page 8 of 8 Policy Numt;ier: BK056113743 COMMERCIAL GENERAL LIABIUTY CG 86 11 04 13 --- = - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU - CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insur-ance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. under Section II -Who Is An Insured is amended to incl ude as an insured any person or organization whom you have agreed to add as an additional insu red in a written contract or written agreement. Such person or organization is an additiona l insured but only with respect to liability for "bodily injury" or "property damage": 1. Caused by "your work" performed foi-that additional insured that is the subject of the written contract or wriiien agreement: and 2. Included in the "products-comp le ted operation s hazard". However: a) The insurance afforded to such additional insured only applies to the extent permitted by law; and b) If coverage provided to the additional insui-ed is required by a contrnct or agreement, the insurance afforded to such additional Insured will not be broader than that whi ch you a re required by the contract or agreement to provide for such additional insu red The insurance provided by this endorsement applie s only if the written contract or w ritten agreement is signed prior to the "bodily injur·y" or "properiy damage". We have no duty to defend an additiona l insu red under this endorsement until we rece ive written notice of a "suit" by the additional insure d as required in Paragraph b. of Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV -Commercial General Liability Conditions. B. With r-espect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I -Coverage A -Bodily Injury And Property Damage Liability: This insurance does not apply to: 1. "Bodily in jury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily inju ry " or "propeliy damage" occurs. 2. "Bodily injury" or "property damage" arising out of the rendering of, or the fa ilure to render , any professional archite ctura l , engineering or surveying services including: a. The prepar ing, approving or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field or-ders, change orders or d rawing and specifications; and b. Supervisory, in spection, architectural m engineering activi ti es. © 2013 Liberty Mutual Insurance CG 86 11 04 13 Includ es copyr ighted materi a l of I nsu ranee SeNices Office, Inc., with its permission _ Page 1 of 2 C. With respect to the insurance affo rded to these additional insu reds, the followin g is added to Section II - Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement , the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by contract or agreement : or 2. Available under the applicable Limits of Insurance shown in the Declaration. whichever is less. This endorsement shall not increase the applicable Um its of Insurance s l1own in the Oeclaratlo ns. D. Witl1 respect to the insurance affmded by this endorsement, Section IV · Commercial General Liability Conditions is amended as follows: 1. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claims Or Suit: An additional i1,sured under this endorsement will as soon as practicable : a. Give written notice of an "occurrence" or an offense that may result in a claim or "su it" under triis insurance to us; b. Tender the defense and indemnity of any clairn or "su it" to all insurers whom aiso have insurance available to the add itional insured: and c. Agree to make available any other insurance wh icl, the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured unde r this endorsement until we receive written notice of a "suit" by the additional insured . 2. Paragraph 4. of Section IV -Commercial General Liability Conditions is amended as follows: a. The fol lowing is added to Paragraph a. Primary Insurance: If an additional insured 's policy has an Other Insurance prevision making its policy excess, and you l1ave agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy sha ll be p1·ima1·y and we will not seek contribution from the additional lnsured 's policy for damages we cover. b. The fol lowing is added to Paragraph b. Excess Insurance: CG 86 11 04 13 When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additio nal insured does not require this insurance to be prirnary or priniary and non-cor,tributorwy, this insuran~ is excess over any other insu1·ance for which the additional insu1·ed is designa ted as a Named Insured. Regardless of the written agreement between you and an additional insured, this in su r- ance is excess over any other insu1·ance whether pr imary , excess , contingent or on any other basis for which the additional insured has been added as an add itional insured on other policies. © 2013 Liberty Mutual ln~urance Inc ludes copyrighted material of I nsu ran ee SeNices Office . Inc .. with its riermission . Page 2 of 2 COMMERCIAL AUTO CA 88 10 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGE INDEX SUBJECT ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT , CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO , VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BROAD FORM INSURED BODILY INJURY REDEFINED EMPLOYEES AS INSUREDS (including employee hired auto) EXTENDED CANCELLATION CONDITION EXTRA EXPENSE-BROADENED COVERAGE GLASS REPAIR -WAIVER OF DEDUCTIBLE HIRED AUTO PHYSICAL DAMAGE (including employee h ired auto and loss of use) HIRED AUTO COVERAGE TERRITORY LOAN / LEASE GAP PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) PERSONAL EFFECTS COVERAGE PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR TWO OR MORE DEDUCTIBLES UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION II -LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED PROVISION NUMBER 3 12 19 5 13 1 22 2 23 10 15 6 20 14 16 11 8 9 4 7 17 18 20 SECTION II -LIABILITY COVERAGE, paragraph A.1 . -WHO IS AN INSURED is amended to include the following as an i nsured: CA88100113 d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured " does not include any organization that: (1) Is a partnership or joint venture ; or (2) Is an insured under any other automobile policy ; or (3) Has exhausted its Limit of Insurance under any other automobile policy . Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock . This automatic coverage is afforded only for 180 days from the date of acquisition or formation . However, coverage under this provision does not apply : (1) If there is similar insurance or a self-insured retention plan available to that organization; © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc., wi th its permission . Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been ex hausted ; or (3) To "bodily injury " or "property damage" that occurred before you acquired or formed the organization . 2. EMPLOYEES AS INSUREDS SECTION II -LIABILITY COVERAGE , paragraph A.1 . -WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee " of yours while using a covered "auto " you do not own , hi re or borrow, but only for acts w ithin the scope of their employment by you . Insurance provided by this endorsement is excess over any other insurance available to any "employee ". g . An "employee" of yours while operating an "auto " hired or borrowed under a written contract or agreement in that "employee 's" name, with your permission , while performing duties related to the conduct of your business and within the scope of the ir employment. Insurance provided by this endorsement is excess over any other insurance available to the "emp loyee ". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II -LIABILITY COVERAGE , paragraph A.1 . -WHO IS AN INSURED is amended to include the following as an insured : h. Any person or organization with respect to the operation , maintenance or use of a covered "auto ", provided that you and such person or organization have agreed in a written contract , agreement , or permit issued to you by governmental or public authority , to add such person , or organizat ion , or governmental or public authority to this policy as an "insured ". However, such person or organization is an "insured ": (1) Only with respect to the operation , maintenance or use of a covered "auto "; (2) Only for "bod ily injury " or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement , or the permit has been issued to you ; and (3) Only for the duration of that contract , agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II -LIABILITY COVERAGE , Coverage Extensions , 2.a . Supplementary Payments, paragraphs (2) and (4) are replaced by the following : (2) Up to $3 ,000 for cost of bail bonds (including bonds for re lated traffic violations) required because of an "accident" we cover. We do not have to furnish these bonds . (4) Al l reasonable expenses incurred by the insured at our request , including actual loss of earnings up to $500 a day because of time off from work . 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where , by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule , or sim ilar protection , the following provision is added : SECTION II -LIABILITY , exclusion B.5 . FELLOW EMPLOYEE does not apply if the "bodi ly injury " results from the use of a covered "auto " you own or hire . SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE CA 88 10 01 13 Pa ragraph A.4. Coverage Extensions of SECTION Ill -PHYSICAL DAMAGE COVERAGE , is amended by adding the following : If hired "autos " are covered "autos " fo r Liab ility Coverage , and if Comprehensive , Specified Causes of Loss or Collision coverage are provided under the Bus iness Auto Cove rage Form for any "auto " you own , then the Physical Damage coverages provided are extended to "autos ": a. You hire , rent or borrow; or © 20 13 Libe rty Mutual Insurance Includes copyrighted material of Insuran ce Services Office, In c., with its permi ss ion . Page 2 of 7 b. Your "employee" hires or rents under a written contract or agreement in that "employee 's" name , but only if the damage occurs while the vehicle is being used in the conduct of your business , subject to the following limit and deductible: A. The most we will pay for "loss " in any one "accident" or "loss " is the smallest of: (1) $50,000 ; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss "; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality , minus a deductible. B . The deductible will be equal to the largest deductible applicable to any owned "auto " for that coverage . C. Subject to the limit, deductib le and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto " you own. D. Subject to a ma ximum of $1 ,000 per "accident", we will also cover the actual loss of use of the hired "auto " if it results from an "accident ", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to : (1) Any "auto " that is hired , rented or borrowed with a driver; or (2) Any "auto" that is hired , rented or borrowed from your "employee ". For the purposes of this provision, SECTION V -DEFINITIONS is amended by adding the following : "Total loss " means a "loss " in which the cost of repairs plus the salvage value exceeds the actual cash value . 7. TOWING AND LABOR SECTION Ill -PHYSICAL DAMAGE COVERAGE , paragraph A.2 . Towing , is amended by the add ition of the following : We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck " is disabled: a . For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks ", we will pay up to $50 per disablement. "Light trucks " are trucks that have a gross vehicle weight (GVW) of 10 ,000 pounds or less. c. For "medium trucks ", we will pay up to $150 per disablement. "Medium trucks " are trucks that have a gross vehicle weight (GVW) of 10 ,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE CA88100113 Paragraph A.4.a ., Coverage Extension of SECTION Ill -PHYSICAL DAMAGE COVERAGE , is amended to provide a limit of $50 per day and a ma ximum limit of $1 ,500 © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc ., with its permission . Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE , A. COVERAGE , is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day , and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE -BROADENED COVERAGE Under SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE , we will pay for the expense of returning a stolen covered "auto " to you. The ma~imum amount we will pay is $1 ,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION Ill -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following : If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto ." The insurance provided under this provision is excess over any other collectible insurance . B. SECTION V-DEFINITIONS is amended by adding the following: For the purposes of this provision , "personal effects" mean tangible property that is worn or carried by an insured ." "Personal effects" does not include tools, equipment , jewelry, money or securities . 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the following : If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty . However, we agree to pay any deductible applicable to the other coverage or warranty . 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE CA88100113 SECTION Ill -PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclusions 4.c . and 4.d . is deleted and replaced with the following: © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc., with its permission. Page 4 of 7 Exclusion 4.c. and 4.d . do not apply to: a. Electronic equipment that receives or transmits audio , visual or data signals , whether or not designed solely for the reproduction of sound , if the equipment is permanently installed in the covered "auto " at the time of the "loss " and such equipment is designed to be solely operated by use of the power from the "auto 's" electrical system , in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or If the "loss " occurs solely to audio , visual or data electronic equipment or accessories used with this equipment , then our obligation to pay for , repair , return or replace damaged or stolen property will be reduced by a $100 deductible . 14. LOAN/ LEASE GAP COVERAGE CA 88 10 01 13 A . Paragraph C., LIMIT OF INSURANCE of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by adding the following : The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the : 1 . Balance due under the terms of the loan or lease to which the damaged covered "auto " is subject at the time of the "loss " less the amount of: a . Overdue payments and financial penalties associated with those payments as of the date of the "loss ", b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear, c. Costs for extended warranties , Credit Life Insurance , Health , Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases , e . Final payment due under a "Balloon Loan ", f. The dollar amount of any unrepaired damage which occurred pri or to the "total Joss " of a covered "auto ", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", i. Any amount representing taxes , j . Loan or lease termination fees; or - 2 . The actual cash value of the damage or stolen property as of the time of the "loss ". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss ". This adjustment is not applicable in Texas . B. ADDITIONAL CONDITIONS This coverage applies only to the orig inal loan for which the covered "auto " that incurred the Joss serves as collateral, or lease written on the covered "auto " that incurred the Joss .. C . SECTION V-DEFINTIONS is changed by adding the following : As used in this endorsement provision , the following defin itions apply : "Total loss " means a "loss " in which the cost of repairs plus the salvage value exceeds the actual cash value . A "balloon Joan " is one with periodic payments that are insufficient to repay the balance over the term of the loan , thereby requiring a large final payment. © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc., with its permission . Page 5 of 7 15. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass·is repaired rather than replaced . 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss " caused by collision to such covered "auto " of the private passenger type or light weight truck with a gross vehicle weight of 10 ,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured "; b. Legally parked; and c. Unoccupied . The "loss" must be reported to the police authorities within 24 hours of known damage . The total amount of the damage to the covered "auto " must exceed the deductible shown in the Declarations . This provision does not apply to any "loss " if the covered "auto" is in the charge of any person or organization engaged in the automobile business . 17. TWO OR MORE DEDUCTIBLES Under SECTION Ill PHYSICAL DAMAGE COVERAGE , if two or more company policies or coverage forms apply to the same accident, the following applies to paragraph D. Deductible : a. If the applicable Business Auto deductible-is the smaller (or smallest) deductible it will be waived ; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced by the amount of the smaller (or smallest) deductible ; or c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest) deductible will be waived . For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group. SECTION IV -BUSINESS AUTO CONDITIONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDITIONS , Paragraph B.2 . is amended by adding the following: If you un intentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form , the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS CA88100113 SECTION IV -BUSINESS AUTO CONDITIONS , paragraph A.2.a. is replaced in its entirety by the following : a. In the event of "accident", claim , "suit " or "J_oss ", you must promptly notify us when it is known to : 1. You , if you are an individual ; 2 . A partner, if you are a partnership ; 3 . Member, if you are a limited liability company ; 4 . An executive officer or the "employee " designated by the Named Insured to g ive such notice , if you are a corporation . © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office , Inc ., with its permission . Page 6 of 7 To the extent possible , notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds " name and address ; and (3) The names and addresses of any injured persons and witnesses . 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV -BUSINESS AUTO CONDITIONS , paragraph A.5., Transfer of Rights of Recovery Against Others to Us , is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also . 21. HIRED AUTO COVERAGE TERRITORY SECTION IV -BUSINESS AUTO CONDITIONS , paragraph 8.7 ., Policy Period , Coverage Territory , is amended by the addition of the following: f . For "autos " hired 30 days or less , the coverage territory is anywhere in the world , provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits , in the United States, the territories and possessions of the United States of America , Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto " hired , leased , rented or borrowed with a driver. SECTION V -DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V -DEFINTIONS , definition C . is replaced by the following : "Bodily injury " means physical injury , sickness or disease sustained by a person , including mental anguish , mental injury, shock, fright or death resulting from any of these at any time . COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION CA 8810 0113 COMMON POLICY CONDITIONS, paragraph A.-CANCELLATION condition applies except as follows : If we cancel for any reason other than nonpayment of premium , we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation . Th is provision does not apply in those states which require more than 60 days prior notice of cancellation . © 201 3 Liberty Mutual Insurance Includes copyrighted mate rial of Insurance Services Office , Inc., with its pe rmission . Page 7 of 7 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04108 (Ed . 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone l i able 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% of the total manual premium otherwise due on such remuneration . The minimum premium for this endorsement is $350 . This agreement shall not operate d i rectly or indirectly to benefit anyone not named in the Schedule. BLANKET WAIVER Person/Organization Job Description All CA Operations SCHEDULE Blanket Waiver -Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium 767.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated . (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 09/01/2018 Insured Insurance Company WC 99 04 108 (Ed . 9-14) Oak River Insurance Company Policy N Endorsement No. Premium$ Countersigned by _______________ _