Loading...
15-200 Elcor Electric, Agreement to preform electrical work in connection with the Cupertino Rom Light Replacement projectRECORDING REQUESTED BY City of Cupertino WHEN RECORDED MAIL TO City Clerk's Office City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 NO FEE IN ACCORDANCE WITH GOV. CODE 27283 DOCUMENT: 23211235 II llUl/1111111111 II 1111 111 REGINA ALCOMENDRAS SANTA CLARA COUNTY RECORDER Recorded at the request of School/College District Fees .... Taxes .. Copies . AMT PAID Pages: 5.00 5.00 RDE # 002 2/02/2016 12:20 PM (SPACE ABOVE THIS LINE FOR RECORDER'S USE) NOTICE OF COMPLETION CITY PROJECT NAME: Cupertino Room Lighting Replacement (Elcor Electric) ftll Original D For Fast Endorsement 4 City of Cupertino NOTICE OF COMPLETION is hereby given in order to comply with the provisions of Section 27283 of the Government Code. This is to certify that the Notice of Completion dated February 1, 2016 for CITY PROJECT NAME: Cupertino Room Lighting Replacement (Elcor Electric) and the City of Cupertino, a governmental agency is hereby accepted by the City of Cupertino on February 1, 2016 and the grantee consents to recordation thereof by its duly authorized officer. I certify under Penalty of Perjury under the laws of the State of California that the foregoing paragraph is true and correct. Dated: February 2, 2016 By: c4lW--.,~ Lauren Sapudar Senior Office Assistant CUPERTINO Recording Requested By: When Recorded Mail To: City of Cupertino 10300 Torre Ave. Cupertino, CA 95014 SPACE ABOVE THIS LINE IS FOR RECORDER'S USE NOTICE OF COMPLETION Civil Code§§ 8182, 8184, 9204, and 9208 NOTICE IS HEREBY GIVEN THAT: 1. The undersigned is the agent of the owner of the project described below. 2. Owner's full name is: City of Cupertino, California. 3. Owner's address is: City Hall, 10300 Torre Ave., Cupertino, CA 95014. 4. The nature of owner's interest in the project is: _i_ Fee Ownership Lessee Other: _________ _ 5. Construction work on the project performed on the owner's behalf is generally described as follows: City Project Name: (City Project No.: Cupertino Room Lighting Replacement 2016-07) Remove existing pendant light fixtures in the Cupertino Room at the Quinlan Community Center and install new pendant light fixtures. 6. The names of the original contractors for the project are: =E=lc~o~r =E~le~c~tr=ic ________ _ 7. The project was completed on: ---=D=-e=c=-=e""'m"'""b"""e""-r=2-=-3....,2=0'-'1'-=5 _____________ _ 8. The project is located at: ___ ___,_10=-1'"""""8"""5'--'N-".'-'S=t=e=lli'"""ng;:z....:....R=d.!..L. ·--=C=-=u=p'-=e""""'rt"'-in=o.,_, =C:....:A--=9:....:5c..=0-=-14-=----- Verification: In signing this document, I, the undersigned, declare under penalty of perjury under the laws of the State of California that I have read this notice, and I know and understand the contents of this notice, and that the facts stated in this notice are true and correct. February 1, 2016; Santa Clara County ---~~"""'----<':--""::::""'s=---------- Date and Place ~ Timm Borden Director of Public Works and City Engineer++ CITY OF CUPERTINO CITY HALL 10300 TORRE AVENUE~ CUPERTINO, CA 95014-3266 (408) 777-3354 -FAX (408) 777-3333 CUPERTINO NOTICE OF ACCEPTANCE PROJECT NAME: Quinlan Community Center Cupertino Room Lighting Replacement City Project Number 2016-07 Owner: City of Cupertino 10300 Torre A venue Cupertino, CA 95014 Direct Contractor: Elcor Electric 3310 Bassett St. Site Location: 10185 N. Stelling Rd. Cupertino, CA 95014 Santa Clara, CA 95054 Work Description: Replace existing pendant light fixtures ·with new. Contract Date: December 7, 2015 Date of Project Acceptance: February 1, 2016 NOITCE IS HEREBY GIVEN THAT I, Timm Borden, Director of Public Works and City Engineer of the City of Cupertino, California, do hereby certify that the improvements performed at the referenced site and as described above and in the referenced contract, which was entered into, by, and between the City of Cupertino and the Direct Contractor on the date noted above, in accordance with the plans and specifications for said work, have been completed to the City's satisfaction, subject to exceptions, and accepted as noted above. ~~:s- Timm Borden Director of Public Works and City Engineer [Notice of Accept under] 75.150903) February L 2016 Date CITY OF ,., . 10300 Torre Avenue 1111 ~~~fc~~;T~~ Cupertino, CA 95014 CUPERTINO 408-777-3200 NO. ':2..o/6 --)tbb THIS AGREEMENT, made and entered into this 7~ day ofOec.e'-lAkc-'d-otS-is by and between the CITY OF CUPERTINO (Hereinafter "CITY") and ELCOR ELECTRIC 3310 Bassett St., Santa Clara, CA 95054 (address/phone/email) (408) 986-1320, info@elcorelectric.com Hereinafter "CONTRACTOR"), in consideration of their mutual covenants, the parties agree as follows: CONTRACTOR shall provide or furnish the following specified services and/or materials: Perform electrical work in connection with the Cupertino Room Light Replacement project. Check box if services are further described in an Exhibit. EXHIBITS: The following attached exhibits hereby are made part of this Agreement: Exhibit A TERM: The services and/or materials furnished under this Agreement shall commence on December 14, 2015 and shall be completed no later than December 18, 2015 COMPENSATION: For the full performance of this Agreement, CITY shall pay CONTRACTOR: 3,600 California Labor Code, Section 1771 requires the payment of prevailing wages to all workers employed on a Public Works contract in excess of $1,000.00. GENERAL TERMS AND CONDITIONS Hold Harmless. Contractor shall, to the fullest extent allowed by law, indemnify, defend, and hold harmless the City and its officers, officials, agents, employees and volunteers against any and all liability, claims, stop notices, actions, causes of action or demands whatsoever from and against any of them, including any injury to or death of any person or damage to property or other liability of any nature, arising out of, pertaining to, or related to the performance of this Agreement by Contractor or Contractor's employees, officers, officials, agents or independent contractors. Contractor shall not be obligated under this Agreement to indemnify City to the extent that the damage is caused by the sole or active negligence or willful misconduct of City, its agents or employees. Such costs and expenses shall include reasonable attorneys' fees of counsel of City's choice, expert fees and all other costs and fees of litigation. Subcontracting. Contractor has been retained due to their unique skills and Contractor may not substitute another, assign or transfer any rights or obligations under this Agreement. Unless prior written consent from City is obtained, only those people whose names are listed this Agreement shall be used in the performance of this Agreement. Assignment. Contractor may not assign or transfer this Agreement, without prior written consent of CITY. Page 1of3 Short Form Agreement Insurance. Contractor shall file with City a Certificate of Insurance consistent with the following requirements Coverage: Contractor shall maintain the following insurance coverage: (1) Workers' Compensation: Statutory coverage as required by the State of California. (2) Liability: Commercial general liability coverage in the following minimum limits: Bodily Injury: $500,000 each occurrence $1,000,000 aggregate -all other Property Damage: $100,000 each occurrence $250,000 aggregate If submitted, combined single limit policy with aggregate limits in the amounts of $1,000,000 will be considered equivalent to the required minimum limits shown above. (3) Automotive: Comprehensive automotive liability coverage in the following minimum limits: Bodily Injury: $500,000 each occurrence Property Damage: $100,000 each occurrence or Combined Single Limit: $500,000 each occurrence ( 4) Professional Liability: Professional liability insurance which includes coverage for the professional acts, errors and omissions of Consultant in the amount of at least $1,000,000. Subrogation Waiver. Contractor agrees that in the event of loss due to any of the perils for which it has agreed to provide comprehensive general and automotive liability insurance, Contractor shall look solely to its insurance for recovery. Contractor hereby grants to City, on behalf of any insurer providing comprehensive general and automotive liability insurance to either Contractor or City with respect to the services of Contractor herein, a waiver of any right to subrogation which any such insurer of said Contractor may acquire against City by virtue of the payment of any loss under such insurance. Termination of Agreement. The City reserves the right to terminate this Agreement with or without cause with a seven (7)-day notice. The Contractor may terminate this Agreement with or without cause with a seven (7)-day written notice. Non-Discrimination. No discrimination shall be made in the employment of persons under this Agreement because of the race, color, national origin, ancestry, religion, gender or sexual orientation of such person Interest of Contractor. It is understood and agreed that this Agreement is not a contract of employment in the sense that the relationship of master and servant exists between City and undersigned. At all times, Contractor shall be deemed to be an independent contractor and Contractor is not authorized to bind the City to any contracts or other obligations in executing this Page 2of3 Short Form Agreement Agreement. Contractor certifies that no one who has or will have any financial interest under this Agreement is an officer or employee of City. City shall have no right of control as to the manner Contractor performs the services to be performed. Nevertheless, City may, at any time, observe the manner in which such services are being performed by the contractor. The Contractor shall comply with all applicable Federal, State, and local laws and ordinances including, but not limited to, unemployment insurance benefits, FICA laws, and the City business license ordinance. Changes. No changes or variations of any kind are authorized without the written consent of the City. CONTRACT CO-ORDINATOR and representative for CITY shall be: NAME: Chris Orr DEPARTMENT: Public Works This Agreement shall become effective upon its execution by CITY, in witness thereof, the parties have executed this Agreement the day and year first written above. coy:: ,JJ---v 0 ~~1eiB;J{~--B+- APPROVALS DATE / 2 . r · /s;- DATE (?_-(({-{( Page 3of3 Short Form Agreement l\AM EXPENDITURE DISTRIBUTION A-le~ A-cE/./4-f' /2---l/-/S- 420-99-022-900-905-QCC 003-03-01 $ 3,600 October 22, 20 I 5 Mr. Chris Orr City of Cupertino 21251 Stevens Creek Boulevard Cupertino, CA 95014 RE: Fixture Removal eL ELECTRIC Quinlin Community Center -IO 185 N. Stelling, Cupertino Electrical Proposal Dear Sir, EXHIBIT A We are pleased to submit our proposal to perform electrical work for the above referenced project. This proposal was developed from direction provided by the City of Cupertino and a review of the site conducted by Elcor Electric. Our proposal, with qualifications, is as follows: Scope of Work • Remove and re-install light fixtures the week of December 14th-18th. • Remove fixtures from ceiling as required. • Provide all necessary conductors and wire nuts are required to complete scope of work. • This proposal assumes all work shall be performed during normal business hours (Monday -Friday 7:00 A.M. to 3:30 P.M.). • We are excluding drawings, design, permit, overtime, any other special systems, fire alarm system, liquidated damages, temporary power/lighting, any paint and/or patch. Our total bid price for this project is not to exceed $ 3,600.00 The above price is good for twenty (20) days. If you have any questions regarding this proposal, please contact the undersigned at your convenience. Sincerely, <froy :Martinez Troy Martinez ELCOR ELECTRIC Proposal/City of Cupertino/Fixture Removal 10.22.15 ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YY) 7/24/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Producer License Number: OA91339 CONTACT NAME: Julie Lonqwello PHONE 866-966-8928 I FAX 408-271-1802 (A/C, No, Ext): (A/C, No): Asero Insurance Services E-MAIL 200 N. Almaden Blvd., 3rd Floor ADDRESS: San Jose, CA 95110 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Property and Casualty Elcor Electric, Inc. Company of America Attn: Clint Woodley INSURER B: Lloyds of London 3310 Bassett Street INSURER C: Santa Clara, CA 95054 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION No. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY) IMM/DD/YYYY) EACH OCCURRENCE $ 1,000,000 ~COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 0 0 CLAIMS-MADE ~OCCUR PREMISES (Ea occurrence) D x DT22C05200R796TIL 15 07-25-2015 07-25-2016 MED EXP (Any on person) $ 10,000 A D PERSONAL & ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 0 POLICY ~ PROJECT 0 LOG $ OOTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ~ANY AUTO (Ea accident) 0 ALL OWNED AUTOS BODILY INJURY (Per Person) $ 0 SCHEDULED AUTOS DT8105200R796TIL 15 07-25-2015 07-25-2016 A BODILY INJURY (Per Accident) $ ~ HIRED AUTOS PROPERTY DAMAGE $ ~ NON-OWNED AUTOS (Per accident) D ~ UMBRELLA LIAB ~OCCUR EACH OCCURRENCE $ 5,000,000 0 EXCESS LIAB 0 CLAIMS-MADE AGGREGATE $ 5,000,000 A DTSMCUP5200R796TIL 15 07-25-2015 07-25-2016 -- 0 DEDUCTIBLE ~RETENTION $ 10,000 WORKERS COMPENSATION ~PER STATUTE U OTH- AND EMPLOYERS' LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N DT J5200R79615 E.L. EACH ACCIDENT $ A OFFICER/MEMBER/EXCLUDED? D NIA 07-25-2015 07-25-2016 1,000,000 (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF E.L. DISEASE -POLICY LIMIT $ 1,000,000 OPERATION below B Professional Liability-Primary AE141795 10-27-14 10-27-15 LIMIT: $ 2,000,000 AGG: $ 2,000,000 DEDUCTIBLE: Per Claim $ 10,000 B Professional Liability-Excess AE14024 10-27-14 10-27-15 Limit: $ 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Misc. Electrical Work City of Cupertino is named as Additional Insured per endorsement attached. Insurance is Primary. Waiver of Subrogation applies to General Liability and Auto per endorsements attached. NOTE: 30 DAYS NOTICE OF CANCELLATION WILL BE GIVEN EXCEPT 10 DAYS FOR NON-PAYMENT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS City of Cupertino 10300 Torre Avenue AUTHORIZED REPRESENTATIVE Cupertino, CA 95014 J)bl~l~ ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All riahts reserved. INSURED: Elcor Electric POLICY# DT22C05200R796TIL15 COMMERCIAL GENERAL LIABILITY CG D2 46 08 05 2005 The St Paul Travelers Companies, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED -(Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a) Only with respect to liability for "bodily injury", " property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the limits of insurance described in Section Ill -Limits of Insurance. b) The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to that additional insured by this endorsement still is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such "other insurance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: COMMERCIAL GENERAL LIBILITY i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit" cooperate with us in the investigation or settlement of the claim or defense against the "suit" and otherwise comply with all policy conditions. d) The additional insured must tender the defense and indemnity of any claim or "suit" to any provider of other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you, b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Policy No: DT8105200R796TIL15 11-IIS ENDORSEMENT CHANGES 11-IE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENOORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover~ age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en~ dorsement and the rest of your policy carefully to determine rtghts, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS F. HIRED AUTO -LIMITED WORLDWIDE COVERAGE -INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE -GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -LIABILITY COV· ERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II -LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1 .. Who Is An Insured, of SECTION II -LI· ABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your busi~ ness. CA T3 53 0310 © 2010 The Travelers Indemnity Company. Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV -BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. © 2010 The Travelers Indemnity Company. CA T3 53 0310 Includes copyrighted material of Insurance Services Office, Inc. with its permission. INSURED: POLICY# Elcor Electric, Inc. DT22C05200R 796TIL15 by any ordinance, law or building code to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" "property damage" "personal in- jury" or The insurance provided to such state or political subdivision does not apply to: a. Any "bodily injury, sonal injury" or "advertising injury" arising out of operations performed for that state or po- b. Any "bodily injury" or "property damage" in- cluded in the "products-completed operations J. KNOWLEDGE AND NOTICE OF OCCUR-RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV -COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II -Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive officers" or directors (if you are an organiza-tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: (a) Any individual who is: (i) A partner or member of any part- nership or joint venture; (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this CoveraQe Part includes an en-dorsement that prov1desl1m1ted coverage tor "property damage" or pollution "bodily injury" or costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -COMMERCIAL GENERAL LI- ABILITY CONDITIONS: If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a. "Bodily injury" or b. "Personal injury" or caused by an offense that is committed; subsequent to the execution of that contract or agreement. M. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY -RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. ENDORSEMENT WC 99 03 76 ( A) - POLICY NUMBER: DTJ5200R79615 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 03.000% of the California workers' compensation pre- mium. Person or Organization ANY PERSON OR ORGANIZATION FROM WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER Schedule Job Description BLANKET WAIVER OF SUBROGATION 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 07/25/2015 Insured: Elcor Electric, Inc. Policy No. DTJUB5200R79615 Insurance Company: Travelers Property & Casualty Countersigned by Endorsement No. Premium