Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Environmental Compliance Experts LLC; 2025-06-16; PSA25-3708UTIL
PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 1 AGREEMENT FOR PSM/RMP/CALARP REGULATIONS COMPLIANCE ASSISTANCE SERVICES ENVIRONMENTAL COMPLIANCE EXPERTS, LLC THIS AGREEMENT is made and entered into as of the ______________ day of ___________________, 2025, by and between the Carlsbad Municipal Water District, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad, California ("CMWD"), and Environmental Compliance Experts, LLC, a California limited liability company ("Contractor"). RECITALS A. CMWD requires the professional services of a consultant that is experienced in PSM/RMP/CalARP Regulations Compliance Assistance Services. B. Contractor has the necessary experience in providing professional services and advice related to PSM/RMP/CalARP Regulations Compliance Assistance Services. C. Contractor has submitted a proposal to CMWD and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, CMWD and Contractor agree as follows: 1. SCOPE OF WORK CMWD retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A", which is incorporated by this reference in accordance with this Agreement’s terms and conditions. 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California area and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The term of this Agreement will be effective from the date first above written to May 27, 2026. The Executive Manager may amend the Agreement to extend it for four (4) additional one (1) year(s) periods or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, CMWD needs, and appropriation of funds by the CMWD Board of Directors. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 4. TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term shall not exceed Thirty-three thousand five hundred forty dollars ($33,540). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. If CMWD elects to extend the Agreement, the amount shall not exceed Thirty-three thousand five hundred forty dollars ($33,540) per Agreement year. Payment terms are net thirty (30) unless provided otherwise in Exhibit “A”. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 June 16th PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 2 CMWD reserves the right to withhold a ten percent (10%) retention until CMWD has accepted the work and/or Services specified in Exhibit "A". Incremental payments, if applicable, should be made as outlined in attached Exhibit "A". 6. CONSTRUCTION MANAGEMENT SOFTWARE Procore Project Management and Collaboration System. This project may utilize the Owner’s Procore (www.procore.com) online project management and document control platform. The intent of utilizing Procore is to reduce cost and schedule risk, improve quality and safety, and maintain a healthy team dynamic by improving information flow, reducing non-productive activities, reducing rework and decreasing turnaround times. The Contractor is required to create a free web-based Procore user account(s) and utilize web-based training / tutorials (as needed) to become familiar with the system. Unless the Engineer approves otherwise, the Contractor shall process all project documents through Procore because this platform will be used to submit, track, distribute and collaborate on project. If unfamiliar or not otherwise trained with Procore, Contractor and applicable team members shall complete a free training certification course located at http://learn.procore.com/procore-certification- subcontractor. The Contractor is responsible for attaining their own Procore support, as needed, either through the online training or reaching out to the Procore support team. It will be the responsibility of the Contractor to regularly check Procore and review updated documents as they are added. There will be no cost to the Contractor for use of Procore. It is recommended that the Contractor provide mobile access for Windows, iOS located at https://apps.apple.com/us/app/procore-construction-management/id374930542 or Android devices located at https://play.google.com/store/apps/details?id=com.procore.activities with the Procore App installed to at least one on-site individual to provide real-time access to current posted drawings, specifications, RFIs, submittals, schedules, change orders, project documents, as well as any deficient observations or punch list items. Providing mobile access will improve communication, efficiency, and productivity for all parties. The use of Procore for project management does not relieve the contractor of any other requirements as may be specified in the contract documents. 7. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of CMWD. Contractor will be under control of CMWD only as to the result to be accomplished but will consult with CMWD as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of CMWD for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. CMWD will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. CMWD will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify CMWD and the City of Carlsbad within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which CMWD may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At CMWD’s election, CMWD may deduct the indemnification amount from any balance owing to Contractor. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 3 8. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of CMWD. If Contractor subcontracts any of the Services, Contractor will be fully responsible to CMWD for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and CMWD. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by CMWD. 9. OTHER CONTRACTORS CMWD reserves the right to employ other Contractors in connection with the Services. 10. INDEMNIFICATION Contractor agrees to defend (with counsel approved by CMWD), indemnify and hold harmless CMWD and the City of Carlsbad and its officers, elected and appointed officials, employees and volunteers from and against all claims, damages, losses and expenses including attorney’s fees arising out of the performance of the work described herein caused by any willful misconduct or negligent act or omission of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. If Contractor’s obligation to defend, indemnify, and/or hold harmless arises out of Contractor’s performance as a “design professional” (as that term is defined under Civil Code section 2782.8), then, and only to the extent required by Civil Code Section 2782.8, which is fully incorporated herein, Contractor’s indemnification obligation shall be limited to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor, and, upon Contractor obtaining a final adjudication by a court of competent jurisdiction. Contractor’s liability for such claim, including the cost to defend, shall not exceed the Contractor’s proportionate percentage of fault. The parties expressly agree that any payment, attorney’s fee, costs or expense CMWD or the City of Carlsbad incurs or makes to or on behalf of an injured employee under CMWD’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 11. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor’s agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. 11.1 Coverages and Limits. Contractor will maintain the types of coverages and minimum limits indicated below, unless the Risk Manager or Executive Manager approves a lower amount. These Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 4 minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. CMWD, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to CMWD as an additional insured. 11.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an “occurrence” basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 11.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for CMWD). $2,000,000 combined single-limit per accident for bodily injury and property damage. 11.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to CMWD's satisfaction, a declaration stating this. 11.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor’s profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 11.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 11.2.1 CMWD will be named as an additional insured on Commercial General Liability which shall provide primary coverage to CMWD. 11.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 11.2.3 If Contractor maintains higher limits than the minimums shown above, the City requires and will be entitled to coverage for the higher limits maintained by Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage will be available to the City. 11.2.4 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to CMWD sent by certified mail pursuant to the Notice provisions of this Agreement. 11.3 Providing Certificates of Insurance and Endorsements. Prior to CMWD's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to CMWD. 11.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then CMWD will have the option to declare Contractor in breach or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 5 Contractor is responsible for any payments made by CMWD to obtain or maintain insurance and CMWD may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. 11.5 Submission of Insurance Policies. CMWD reserves the right to require, at anytime, complete and certified copies of any or all required insurance policies and endorsements. 12. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 13. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of CMWD during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of four (4) years from the date of final payment under this Agreement. 14. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of CMWD. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to CMWD. Contractor will have the right to make one (1) copy of the work product for Contractor’s records. 15. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in CMWD and Contractor relinquishes all claims to the copyrights in favor of CMWD. 16. NOTICES The name of the persons who are authorized to give written notices or to receive written notice on behalf of CMWD and on behalf of Contractor under this Agreement. For CMWD For Contractor Name Ray Martinez Name Jake Tilley Title Project Manager Title Principal Engineer Department PW Utilities Address 3460 Marron Road, Suite 103-222 California Municipal Water District Oceanside, CA 92056 Address 5950 El Camino Real Phone No. 760-536-3506 Carlsbad, CA 92008 Email jake.tilley@ececonsulting.net. Phone No. 760-802-8097 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 6 Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. 17. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the CMWD Conflict of Interest Code. The Contractor shall report investments or interests as required in the CMWD Conflict of Interest Code. For Labor Compliance Service Agreements, the Contractor further represents, warrants, and declares, under penalty of perjury, interest, as that term is defined in Labor Code Section 1771.8(a)(2) does not exist. Yes ☐ No ☒ If yes, list the contact information below for all individuals required to file: Name Email Phone Number 18. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that the services required by this Agreement. 19. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATIONS Contractor’s vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board (CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets. 20. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 21. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or CMWD will reduce such questions, and their respective views, to writing. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 7 A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the Executive Manager. The Executive Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the Executive Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 22. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, CMWD may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If CMWD decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, CMWD may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by CMWD and all work in progress to CMWD address contained in this Agreement. CMWD will make a determination of fact based upon the work product delivered to CMWD and of the percentage of work that Contractor has performed which is usable and of worth to CMWD in having the Agreement completed. Based upon that finding CMWD will determine the final payment of the Agreement. CMWD may terminate this Agreement by tendering thirty (30) days written notice to Contractor. Contractor may terminate this Agreement by tendering Sixty (60) days written notice to CMWD. In the event of termination of this Agreement by either party and upon request of CMWD, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to CMWD. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. CMWD will make the final determination as to the portions of tasks completed and the compensation to be made. 23. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, CMWD will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 24. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any agreement claim submitted to CMWD must be asserted as part of the agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to CMWD, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If CMWD seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 8 acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for CMWD to terminate this Agreement. 25. JURISDICTION AND VENUE This Agreement shall be interpreted in accordance with the laws of the State of California without regard to, or application of, choice of law rules or principles. Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. 26. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon CMWD and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of CMWD, which shall not be unreasonably withheld. 27. THIRD PARTY RIGHTS Nothing in this Agreement should be construed to give any rights or benefits to any party other than the City and Contractor. 28. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. This Agreement may be executed in counterparts. 29. AUTHORITY The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. [signatures on following page] Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 9 CONTRACTOR CARLSBAD MUNICIPAL WATER DISTRICT, a Public Agency organized under the Municipal Water Act of 1911, and a Subsidiary District of the City of Carlsbad ENVIRONMENTAL COMPLIANCE EXPERTS LLC, a California limited liability company By: By: (sign here) AMANDA L. FLESSE, General Manager, as authorized by the Executive Manager James Tilley, Managing Member (print name/title) ATTEST: By: SHERRY FREISINGER, Secretary (sign here) By: Deputy Secretary (print name/title) If required by CMWD, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups. Group A Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, General Counsel By: _____________________________ City Attorney Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 PSA25-3708UTIL General Counsel Approved Version 2/11/2025 Page 10 EXHIBIT A SCOPE OF SERVICES AND FEE Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 Your Compliance is Our #1 Priority 3460 Marron Road, Suite 103-222 (760) 536-3506 Oceanside, California 92056 info@ececonsulting.net March 12, 2025 Mr. Ray Martinez Carlsbad Municipal Water District 5950 El Camino Real Carlsbad, CA 92008 Sent via email: raymond.martinez@carlsbadca.gov RE: Proposal for CMWD – MAERKLE CHLORINE FACILITIES: PSM/RMP Comprehensive Support ** 2025 Compliance Assistance ** Dear Mr. Martinez: Environmental Compliance Experts (ECE) hereby submits this proposal to provide comprehensive support regarding the City of Carlsbad’s PSM/RMP/CalARP programs associated with the chlorine processes at the Maerkle Chlorine Stations (Upper and Lower). The studies, submission documents, and general support will be conducted in accordance with the requirements of: Cal-OSHA’s Process Safety Management (PSM) [8 CCR § 5189], EPA’s Risk Management Program (RMP) [40 CFR Part 68] regulations, and the California Accidental Release Prevention (CalARP) program [CCR Title 19, Division 5, Chapter 2]. These regulations require that several milestone studies as well as ongoing implementation tasks are completed in order to remain in compliance. ECE proposes to facilitate the required studies and meetings for the Carlsbad Municipal Water District, and to provide the required written reports that detail the findings and recommendations. ECE will also prepare the documents required for submission to both EPA and the CUPA based on the regulatory due dates. This scope of work includes the following tasks based on compliance requirements of the three regulations referenced above: 1)PSM/RMP/CalARP Team Quarterly Meetings w/ SOP Review + Certification 2)PSM/RMP Regulatory Training Class 3)Three-Year Compliance Audit 4)HMBP Assistance + Submission 5)Emergency Action Plan Refresher Training 6)Fire Department Trainings + Exercises 7)Compliance Calendar Development (2026 – 2030) 8)Updates to PSM/RMP Written Programs 9)As-Needed Support Task 1: PSM/RMP/CalARP Team Quarterly Meetings w/ SOP Review + Certification ** Due Quarterly ** ECE will facilitate a quarterly meeting with the Carlsbad Municipal Water District Utilities group to ensure that outstanding issues associated with the PSM/RMP programs for the Maerkle Chlorine Facilities are progressing and are being resolved in a timely manner. Based on the Carlsbad Municipal Water District’s PSM policies, routine meetings with water utilities staff are held to satisfy the Employee Participation element of the regulations, which includes having the opportunity for ongoing input into the development and implementation of the PSM/RMP policies and procedures. PSA25-3708UTIL Exhibit "A" SCOPE OF SERVICES AND FEE Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ENVIRONMENTAL COMPLIANCE EXPERTS Page 2 of 6 Mr. Ray Martinez March 12, 2025 3460 Marron Road, Suite 103-222 (760) 536-3506 Oceanside, California 92056 info@ececonsulting.net ECE will provide expert guidance during the team’s review of recommendation status from studies such as Process Hazard Analyses, Three-Year Compliance Audits, SOP Reviews, Incident Investigations, Regulatory Inspections (including CUPA, Cal-OSHA, and/or EPA), and previous PSM Team Meetings. ECE will also assist the Carlsbad Municipal Water District PSM Team to conduct the review and certification of the written chlorine Operating Procedures on an annual basis as required. A written test will be administered to staff to ensure appropriate transfer of knowledge. ECE will compile notes, findings, and recommendations from these PSM Quarterly Team Meetings and provide the results to the Water Utilities Manager and/or Supervisor. Task 2: PSM/RMP Regulatory Training Class A training class will be provided to Carlsbad Municipal Water District Water Utilities Department to increase awareness of the regulatory requirements associated with the District’s use of chlorine, as well as the various implementation responsibilities assigned to different team members. Each element of the PSM, RMP, and CalARP programs will be detailed to enhance the department’s capabilities to remain in compliance throughout operation of the chlorine processes at the Maerkle Chlorine Facilities. The trainer from ECE will highlight specific duties assigned to water operations personnel and suggest methods for ensuring the recordkeeping is properly conducted and documented. A written test will be provided to all attendees, with a training certificates provided to those who satisfactorily pass. One training class is included in this scope of work that covers the calendar year 2025. Task 3: Three-Year Compliance Audit ** Due June 2025 ** Task 3a: Compliance Audit (On-Site) The Principal Engineer from Environmental Compliance Experts will conduct a one-day site visit at the Carlsbad Municipal Water District offices to review all elements of the Process Safety Management & Risk Management Programs. Using Compliance Audit checklists published by OSHA, EPA, and Cal-EPA, the Auditor will examine the written reports, policies, and procedures that comprise the PSM/RMP/CalARP programs to make an evaluation of the degree of implementation and to identify potential areas for improvement. Discussions with utilities personnel during the Compliance Audit will enable the Auditor to comprehensively evaluate the facility’s implementation and documentation practices. ECE will request access to the following information / documents / records in order to ensure that the Audit fully gauges the level of compliance: Chlorine Piping & Instrumentation Diagrams (P&IDs) Safety Systems (Chlorine Leak Detectors, scrubber system details, halogen valve specs, etc.) Status of Previous Process Hazard Analysis (PHA) Recommendations Status of Previous Compliance Audit Recommendations Written Operating Procedures, SOP Annual Review Documentation PSA25-3708UTIL Exhibit "A" Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ENVIRONMENTAL COMPLIANCE E><PERTS Page 3 of 6 Mr. Ray Martinez March 12, 2025 3460 Marron Road, Suite 103-222 (760) 536-3506 Oceanside, California 92056 info@ececonsulting.net Employee Training Records Chlorine Contractor Training Records & Associated Documentation General Chlorine Awareness training (plant wide) Records of Previous Incident Investigations & Corrective Actions Chlorine Equipment Preventative Maintenance Schedule & Records Emergency Planning & Response Policies / Emergency Action Plan Training Records Hazard Assessment Reports (Worst Case & Alternate Release Scenarios) RMP Management Programs / Organization Chart CalARP Submission documents, CUPA correspondence, CUPA Inspection Reports RMP Submittal Documentation (CDX, RMP*eSubmit) Where gaps are observed in either the written programs or the facility’s recordkeeping practices, the Auditor will note findings, which lead to the development of recommendations. The recommendations will address deviations from regulatory requirements, as well as inconsistencies between the facility’s written programs and recordkeeping practices. Task 3b: Audit Report Preparation & Documentation of Recommendations A comprehensive written Compliance Audit report will be prepared following the on-site audit. The report will include all checklists that document the findings and recommendations, as well as a technical description of the audit process used by the ECE Auditor. The preparation of the audit report is a culmination of the findings and notes observed on-site. It also provides the auditor an opportunity to carefully review the requirements within each PSM, RMP, and CalARP element to ensure all questions in the audit checklists have been affirmatively answered. The Audit Report will contain the required elements as specified by the PSM and RMP rules, which include a written acknowledgement / certification by a facility representative. The audit recommendations will be provided to Audit team members in the DRAFT review phase, prior to the issuance of the final Compliance Audit report. Deliverables include electronic and hard copies of the full Compliance Audit report and recommendation tracking form. The recommendations will be summarized in the report, and an independent status tracking sheet will be provided to the Carlsbad Municipal Water District audit team personnel. As required by the CalARP program, ECE will also assist the Carlsbad Municipal Water District audit team with the preparation of the timeline for completion of the audit recommendations to be submitted to the CUPA for approval. Task 4: Hazardous Materials Business Plan (HMBP) Assistance + Submission ** Due ~September 1 Annually ** The Principal Engineer from ECE will verify quantities for all subject chemicals at the Maerkle Chlorine Facilities. These include chemicals above the State of California’s threshold quantities (55 gallons liquid, 200 ft3 gas, 500 pounds solid). Facilities are also required to indicate key features of the facility on detailed maps including the location of flammable materials, hazardous waste, chemical storage areas, storm drains, fire suppression equipment, eye wash stations, etc. The ECE engineer will update the maps to ensure that the appropriate features are indicated. ECE will prepare the required HMBP documents for submission via the CERS online database. This includes the chemical inventories maintained on-site, facility maps indicating the location of chemicals + additional required elements, a detailed description of the CMWD training policies, as well as a PSA25-3708UTIL Exhibit "A" Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ENVIRONMENTAL COMPLIANCE E><PERTS Page 4 of 6 Mr. Ray Martinez March 12, 2025 3460 Marron Road, Suite 103-222 (760) 536-3506 Oceanside, California 92056 info@ececonsulting.net summary of the Consolidated Emergency Response / Contingency Plan. Based on the specific business activities conducted at the facility, other forms will be completed and included in the certification and submission process as needed (ex: APSA). Task 5: Emergency Action Plan Refresher Training The Principal Engineer from ECE will provide a refresher training class for the Carlsbad Municipal Water District Utilities Department regarding the Emergency Action Plan at the Maerkle Chlorine Facilities. Included in the training curriculum will be the regulatory requirements for each of the applicable regulations (PSM, RMP, CalARP, and HMBP), examples of incidents at other similar facilities that use chlorine, as well as details of the CMWD’s Maerkle Facility Emergency Planning & Response Policy. This includes notification of emergency response agencies (phone calls + written follow-up reports), the evacuation plan for the facility, and contact information for Carlsbad Municipal Water District emergency coordinators and alternates. Task 6: Fire Department Trainings + Exercises ECE will facilitate meetings with the Carlsbad Fire Department to ensure emergency planning protocols are appropriately coordinated, including chlorine release scenarios. Training will be provided to Carlsbad Fire Department personnel to ensure that they are aware of the details of the Maerkle Chlorine Facilities including the location, the potential chemical hazards, and the Carlsbad Municipal Water District’s emergency policies. Multiple meetings will be held with Fire Department personnel and / or San Diego County Hazardous Incident Response Team to ensure all shifts are educated about the details of the CMWD facility. In addition to educating the Fire Department and HazMat Response Team personnel, ECE will assist in facilitating training exercises for the response agencies to ensure maximum readiness for a potential chlorine release incident and/or exposure. These training exercises will be held on-site at the City of Carlsbad’s Maerkle Chlorine Facilities with multiple shifts of response personnel. Task 7: Develop PSM/RMP Compliance Calendar for CY 2026 – 2030 ECE will develop and prepare a Compliance Calendar to enable smooth and seamless implementation and recordkeeping for the PSM/RMP programs associated with the district’s use of chlorine. The Compliance Calendar will be provided in a notebook format and will cover the calendar years of 2026 through 2030. The document will assist the CMWD PSM Team to properly complete and document the routine and ongoing tasks associated with the PSM/RMP programs. Task 8: Updates to PSM/RMP Written Programs Part of the implementation process of the regulatory requirements typically generates suggested changes / updates / revisions / corrections to the PSM/RMP/CalARP documentation. ECE will manage those suggested updates, and provide current revision pages to include in the District’s written programs. These can include minor policy updates, revisions to SOPs, personnel changes, updates based PSA25-3708UTIL Exhibit "A" Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ENVIRONMENTAL COMPLIANCE E><PERTS Page 5 of 6 Mr. Ray Martinez March 12, 2025 3460 Marron Road, Suite 103-222 (760) 536-3506 Oceanside, California 92056 info@ececonsulting.net on revised regulatory interpretations, etc. These updates will also include corrections as noted in studies such as Three-Year Compliance Audits, Five-Year PHA Studies, or Incident Investigations (as appropriate). ECE will provide electronic and/or hard copies of the written program updates. Task 9: As-Needed Support ECE will be available for additional compliance support as the need arises. This task may include support with issues such as: regulatory inspection attendance / follow-up assistance, additional training for District personnel (potentially outside the water operations group), acting as a liaison with interested outside parties such as chlorine delivery contractors / local Fire Departments / City Managers / Council, developing hazardous materials inventories, etc. Recordkeeping will be provided to Water Operations to ensure robust / comprehensive records are kept as they relate to ongoing chlorine compliance. This task will be billed on a Time & Materials basis for labor hours spent by ECE. Project Costs: 2025 PSM/RMP/CalARP Comprehensive Support This proposal is submitted on a fixed-fee basis (except for Tasks 8 & 9*, as noted). The costs associated with providing comprehensive support for the ongoing development and implementation of the Carlsbad Municipal Water District’s PSM/RMP/CalARP programs are detailed below and are based on Tasks 1 – 9 as detailed above. All direct project costs are included such as: travel (mileage), materials, shipping, etc. Task Costs 1 Quarterly PSM/RMP Team Meetings w/ SOP Review + Certification $ 6,520 2 PSM/RMP Regulatory Training Class $ 2,360 3a Three-Year Compliance Audit (Prep + on-site audit) $ 2,320 3b Three-Year Compliance Audit Report (Audit Report + Recommendations) $ 3,070 4 HMBP Assistance + Submission $ 1,540 5 Emergency Action Plan Refresher Training $ 1,160 6 Fire Department Training Meetings + Exercises @ Maerkle $ 8,560 7 Compliance Calendar Development (CY 2026 – 2030) $ 1,550 8 Updates to PSM/RMP Programs* (billed on a Time & Materials basis) $ 3,420 9 As-Needed Support* (billed on a Time & Materials basis) $ 3,040 Project Total Not to Exceed * $ 33,540 * * Includes taxes, fees, expenses and all other costs. PSA25-3708UTIL Exhibit "A" Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ENVIRONMENTAL COMPLIANCE E><PERTS Page 6 of 6 Mr. Ray Martinez March 12, 2025 3460 Marron Road, Suite 103-222 (760) 536-3506 Oceanside, California 92056 info@ececonsulting.net If you have any questions, please contact me at jake.tilley@ececonsulting.net. You can initiate this project by providing a Purchase Order (or similar written authorization) to my attention. Sincerely, Environmental Compliance Experts Jake Tilley Principal Engineer Notes & Compliance 1.This proposal is valid for 90 days. 2.Environmental Compliance Experts complies with the State of California Department of Industrial Relations prevailing wage requirements as detailed in the Public Works Chapter of the California Labor Code, Sections 1720 – 1861. PSA25-3708UTIL Exhibit "A" Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ENVIRONMENTAL COMPLIANCE E><PERTS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 2/13/2025 Inszone Insurance Services,LLC2721CitrusRoad,Suite ARanchoCordova,CA 95742 Certificate Team 877-308-9663 916-400-2625 certs@inszoneins.com License#:0F82764 Nautilus Insurance Co.17370 ENVICOM-01 Environmental Compliance Experts,LLC3460MarronRoadSuite103-222Oceanside,CA 92056 1252741141 A X 2,000,000 X 100,000 5,000 2,000,000 2,000,000 X Y ECP2028270-16 2/4/2025 2/4/2026 2,000,000 AAA PollutionLiabilityPollutionLiabilityProfessionalLiability ECP2028270-16ECP2028270-16ECP2028270-16 2/4/20252/4/20252/4/2025 2/4/20262/4/20262/4/2026 AggregateDeductibleAggregate/EachClaim $2,000,000$2,500$2,000,000 Additional Insured on the General Liability. The aforementioned coverage is provided to the extent in the attached forms for:City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services City of Carlsbad/CMWDc/o EXIGIS Insurance Compliance ServicesPOBox947Murrieta,CA 92564 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1246 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS – ONGOING OPERATIONS – COVERAGE A, B, D.1 & D.4 Policy Number Policy Effective Date Policy Expiration Date Endorsement Effective Date ECP2028270-1 2/4/202 2/4/202 2/4/202 This endorsement modifies insurance provided under the following: ENVIRONMENTAL COMBINED POLICY I. SECTION III – WHO IS AN INSURED is amended to include as an additional insured: 1.Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and 2.Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement. Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Coverage D.1 – Contractors Pollution Legal Liability and Coverage D.4 – Microbial Substance Contractors Pollution Liability, or personal injury or advertising injury under SECTION I - COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY directly caused by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured described in Paragraph 1. or 2. above. However, the insurance afforded to such additional insured described above: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured, and c.Will not extend beyond that which is provided to you in this policy. A person’s or organization’s status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. II.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. Bodily injury, property damage or personal and advertising injury arising out of the rendering 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 activities. 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. b. Bodily injury or property damage occurring after: (1)All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, 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 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1246 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 2 of 2 (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. III.With respect to the insurance afforded to these additional insureds, the following is added to SECTION V – LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement described in Paragraph I.1.; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. IV.With respect to the insurance afforded to these additional insureds, the following is added to SECTION VI – REPORTING, DEFENSE, SETTLEMENT & COOPERATION: 1. Duties -- Additional Insured An additional insured must see to it that: a.We are notified in writing as soon as practicable of an occurrence or offense which may result in a claim or suit; b.We receive written notice of a claim or suit as soon as practicable; and c.A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory. V. SECTION VII – CONDITION 10. – Other Insurance is amended by the addition of the following which supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that: 1.The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement. However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project- specific, primary insurance. VI.This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1248 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS – COMPLETED OPERATIONS – COVERAGE A, D.1 & D.4 Policy Number Policy Effective Date Policy Expiration Date Endorsement Effective Date ECP2028270-1 2/4/202 2/4/202 2/4/202 This endorsement modifies insurance provided under the following: ENVIRONMENTAL COMBINED POLICY I. SECTION III – WHO IS AN INSURED is amended to include as an additional insured: 1.Any person or organization for whom you have performed operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and 2.Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement. Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Coverage D.1 – Contractors Pollution Legal Liability and Coverage D.4 – Microbial Substance Contractors Pollution Liability, directly caused by your work performed for the additional insured described in Paragraph 1. or 2. above, and included in the products-completed operations hazard. However, the insurance afforded to such additional insured described above: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and c.Will not extend beyond that which is provided to you in this policy. II.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. Bodily injury or property damage arising out of the rendering 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 activities. 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 involved the rendering of, or the failure to render any professional architectural, engineering or surveying services. III.With respect to the insurance afforded to these additional insureds, the following is added to SECTION V – LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement described in Paragraph I.1.; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. IV.With respect to the insurance afforded to these additional insureds, the following is added to SECTION VI – Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1248 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 2 of 2 REPORTING, DEFENSE, SETTLEMENT & COOPERATION: 1. Duties -- Additional Insured An additional insured must see to it that: a.We are notified in writing as soon as practicable of an occurrence which may result in a claim or suit; b.We receive written notice of a claim or suit as soon as practicable; and c.A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory. V. SECTION VII – CONDITION 10. – Other Insurance is amended by the addition of the following which supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that: 1.The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement. However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project- specific, primary insurance. VI.This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 2/13/2025 Inszone Insurance Services,LLC2721CitrusRoad,Suite ARanchoCordova,CA 95742 Certificate Team 877-308-9663 916-400-2625 certs@inszoneins.com License#:0F82764 Nautilus Insurance Co.17370 ENVICOM-01 Environmental Compliance Experts,LLC3460MarronRoadSuite103-222Oceanside,CA 92056 1252741141 A X 2,000,000 X 100,000 5,000 2,000,000 2,000,000 X Y ECP2028270-16 2/4/2025 2/4/2026 2,000,000 AAA PollutionLiabilityPollutionLiabilityProfessionalLiability ECP2028270-16ECP2028270-16ECP2028270-16 2/4/20252/4/20252/4/2025 2/4/20262/4/20262/4/2026 AggregateDeductibleAggregate/EachClaim $2,000,000$2,500$2,000,000 Additional Insured on the General Liability. The aforementioned coverage is provided to the extent in the attached forms for:City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services City of Carlsbad/CMWDc/o EXIGIS Insurance Compliance ServicesPOBox947Murrieta,CA 92564 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1246 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS – ONGOING OPERATIONS – COVERAGE A, B, D.1 & D.4 Policy Number Policy Effective Date Policy Expiration Date Endorsement Effective Date ECP2028270-1 2/4/202 2/4/202 2/4/202 This endorsement modifies insurance provided under the following: ENVIRONMENTAL COMBINED POLICY I. SECTION III – WHO IS AN INSURED is amended to include as an additional insured: 1.Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and 2.Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement. Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Coverage D.1 – Contractors Pollution Legal Liability and Coverage D.4 – Microbial Substance Contractors Pollution Liability, or personal injury or advertising injury under SECTION I - COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY directly caused by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured described in Paragraph 1. or 2. above. However, the insurance afforded to such additional insured described above: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured, and c.Will not extend beyond that which is provided to you in this policy. A person’s or organization’s status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. II.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. Bodily injury, property damage or personal and advertising injury arising out of the rendering 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 activities. 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. b. Bodily injury or property damage occurring after: (1)All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, 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 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1246 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 2 of 2 (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. III.With respect to the insurance afforded to these additional insureds, the following is added to SECTION V – LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement described in Paragraph I.1.; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. IV.With respect to the insurance afforded to these additional insureds, the following is added to SECTION VI – REPORTING, DEFENSE, SETTLEMENT & COOPERATION: 1. Duties -- Additional Insured An additional insured must see to it that: a.We are notified in writing as soon as practicable of an occurrence or offense which may result in a claim or suit; b.We receive written notice of a claim or suit as soon as practicable; and c.A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory. V. SECTION VII – CONDITION 10. – Other Insurance is amended by the addition of the following which supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that: 1.The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement. However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project- specific, primary insurance. VI.This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1248 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS – COMPLETED OPERATIONS – COVERAGE A, D.1 & D.4 Policy Number Policy Effective Date Policy Expiration Date Endorsement Effective Date ECP2028270-1 2/4/202 2/4/202 2/4/202 This endorsement modifies insurance provided under the following: ENVIRONMENTAL COMBINED POLICY I. SECTION III – WHO IS AN INSURED is amended to include as an additional insured: 1.Any person or organization for whom you have performed operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and 2.Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement. Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Coverage D.1 – Contractors Pollution Legal Liability and Coverage D.4 – Microbial Substance Contractors Pollution Liability, directly caused by your work performed for the additional insured described in Paragraph 1. or 2. above, and included in the products-completed operations hazard. However, the insurance afforded to such additional insured described above: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and c.Will not extend beyond that which is provided to you in this policy. II.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: a. Bodily injury or property damage arising out of the rendering 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 activities. 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 involved the rendering of, or the failure to render any professional architectural, engineering or surveying services. III.With respect to the insurance afforded to these additional insureds, the following is added to SECTION V – LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement described in Paragraph I.1.; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. IV.With respect to the insurance afforded to these additional insureds, the following is added to SECTION VI – Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 ECP 1248 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 2 of 2 REPORTING, DEFENSE, SETTLEMENT & COOPERATION: 1. Duties -- Additional Insured An additional insured must see to it that: a.We are notified in writing as soon as practicable of an occurrence which may result in a claim or suit; b.We receive written notice of a claim or suit as soon as practicable; and c.A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory. V. SECTION VII – CONDITION 10. – Other Insurance is amended by the addition of the following which supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that: 1.The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement. However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project- specific, primary insurance. VI.This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 AUTOMOBILE POLICY PACKET POLICY PERIOD: IMPORTANT MESSAGES Refer to your Declarations Page and endorsements to verify that coverages, limits, deductibles and other policy details are correct and meet your insurance needs. Required information forms are also enclosed for your review. To receive this document and others electronically, or manage your Auto Policy online, go to usaa.com. For U.S. calls: Policy Service (800) 531-8111. Claims (800) 531-8222. ACS1 49708-0406 PAGE 1 MAIL MCH-M-I 7987 Y1392 DECEMBER 20,2024 JAMES K TILLEY CIC 00806 14 21 7101 7 EFFECTIVE JAN 25 2025 TO JUL 25 2025 Please refer to attached form entitled "Notice of Information Practices" for privacy notice information. Check your vehicle for a safety recall today!Visit www.usaa.com/autorecall to learn more. Your renewal policy contains some important changes.Please read the attached form,IMPORTANT CHANGES TO YOUR AUTO POLICY,for details about these changes. For information about the available discounts and the factors we use to determine premiums,please read the enclosed flier,"Information Used to Determine Your Premium." With this renewal,your premium has increased due to a rate change in your state or because of your policy's individual risk characteristics.See your Declarations for the new premium.Contact us if you have any questions. Thank you for renewing your policy and allowing us to continue servicing your insurance needs.If you have any concerns or need to modify or cancel the renewal policy,please contact us immediately. This is not a bill.Any premium charge or change for this policy will be reflected on your next regular monthly statement.Your current billing statement should still be paid by the due date indicated. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 THIS PAGE INTENTIONALLY LEFT BLANK PAGE 2Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 AUTOMOBILE POLICY PACKET CONTINUED ACS2 PAGE 3 CIC 00806 14 21 7101 7 Your Uninsured Motorists Bodily Injury Coverage (UMBI)and Uninsured Motorists Property Damage (UMPD)selection/rejection remains in effect.You may quote different coverage limits and make changes at any time to your policy on usaa.com.Or you may call us at 1-800-531-USAA (8722). You may exclude from coverage any operator who does not qualify for the California Good Driver Discount.Please refer to the enclosed flier, "Information Used to Determine Your Premium." Your safety matters to USAA.Visit http://usaa.com/autoadvice for our latest auto insurance and driving safety tips. Coverage exclusions apply when your vehicle is used in ride sharing.If you need coverage for ride sharing activities,we're pleased to offer Ride Share Gap Protection.Please contact us for more information or to obtain a quote. You may designate a third party to receive notice of policy cancellation or nonrenewal by completing the attached form 40CA. FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING:ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT INFORMATION TO OBTAIN OR AMEND INSURANCE COVERAGE OR TO MAKE A CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. USAA considers many factors when determining your premium.Maintaining safe driving habits is one of the most important steps you can take in keeping your premium as low as possible.A history of claim or driving activity and your USAA payment history may affect your policy premium. We have provided your ID cards in this packet.You can use the cards to show proof of insurance,if necessary. Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 b a c kCALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC California Evidence of Financial Responsibility Keep this card. IMPORTANT:The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must provide evidence of financial responsibility at the scene.f Failure to comply is an infraction and shall be punishable byofines, impoundment or license suspension.l d Insurance Company Policy Number Effective Date Expiration Date Additional copies available at usaa.comVehicle Make/Vehicle Identification Number Year This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicle and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy.9800 Fredericksburg Road, San Antonio, Texas 78288 California Automobile Insurance Identification Cards We've issued two identification cards as evidence of liability insurance for your vehicle(s). These cards are valid only as long as liability insurance remains in force.Keep a copy of the ID card in your vehicle at all times. You may be required to produce your identification card at vehicle registration or inspection, when applying for a driver's license, following an accident, or upon a law enforcement officer's request. 53CA1 Rev. 06-13 55047-0513_02 b a c k CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC California Evidence of Financial Responsibility Keep this card. IMPORTANT:The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must f provide evidence of financial responsibility at the scene. o Failure to comply is an infraction and shall be punishable by l fines, impoundment or license suspension. d Insurance Company Policy Number Effective Date Expiration Date Vehicle Make/Vehicle Identification Number Year Additional copies available at usaa.com This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicle and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy.9800 Fredericksburg Road, San Antonio, Texas 78288 PAGE 4 25968 JAMES K TILLEY JAMES K TILLEY HEATHER L TILLEY USAA CASUALTY INSURANCE COMPANY 00806 14 21C 7101 7 01/25/25 07/25/25 NISSAN 1N4AL3AP4FC169119 2015 CONTACT US:210-531-USAA(8722) OR 800-531-USAA 12/20/24 25968 JAMES K TILLEY JAMES K TILLEY HEATHER L TILLEY USAA CASUALTY INSURANCE COMPANY 00806 14 21C 7101 7 01/25/25 07/25/25 NISSAN 1N4AL3AP4FC169119 2015 CONTACT US:210-531-USAA(8722) OR 800-531-USAA Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 b a c kCALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC California Evidence of Financial Responsibility Keep this card. IMPORTANT:The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must provide evidence of financial responsibility at the scene.f Failure to comply is an infraction and shall be punishable byofines, impoundment or license suspension.l d Insurance Company Policy Number Effective Date Expiration Date Additional copies available at usaa.comVehicle Make/Vehicle Identification Number Year This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicle and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy.9800 Fredericksburg Road, San Antonio, Texas 78288 California Automobile Insurance Identification Cards We've issued two identification cards as evidence of liability insurance for your vehicle(s). These cards are valid only as long as liability insurance remains in force.Keep a copy of the ID card in your vehicle at all times. You may be required to produce your identification card at vehicle registration or inspection, when applying for a driver's license, following an accident, or upon a law enforcement officer's request. 53CA2 Rev. 06-13 55047-0513_02 b a c k CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC California Evidence of Financial Responsibility Keep this card. IMPORTANT:The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must f provide evidence of financial responsibility at the scene. o Failure to comply is an infraction and shall be punishable by l fines, impoundment or license suspension. d Insurance Company Policy Number Effective Date Expiration Date Vehicle Make/Vehicle Identification Number Year Additional copies available at usaa.com This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicle and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy.9800 Fredericksburg Road, San Antonio, Texas 78288 PAGE 5 25968 HEATHER L TILLEY JAMES K TILLEY 1774 COTTONWOOD DR VISTA CA 92081-4500 JAMES K TILLEY HEATHER L TILLEY USAA CASUALTY INSURANCE COMPANY 00806 14 21C 7101 7 01/25/25 07/25/25 KIA 5XYP64HC5NG305160 2022 CONTACT US:210-531-USAA(8722) OR 800-531-USAA 12/20/24 25968 HEATHER L TILLEY JAMES K TILLEY JAMES K TILLEY HEATHER L TILLEY USAA CASUALTY INSURANCE COMPANY 00806 14 21C 7101 7 01/25/25 07/25/25 KIA 5XYP64HC5NG305160 2022 CONTACT US:210-531-USAA(8722) OR 800-531-USAA Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 USAA CASUALTY INSURANCE COMPANY (A Stock Insurance Company)State Veh POLICY NUMBER 9800 Fredericksburg Road - San Antonio, Texas 78288 Terr POLICY PERIOD:(12:01 A.M. standard time) Named Insured and Address WORK/SCHOOLVEH USE*Description of Vehicle(s)Miles DaysANNUALOnePerVEHYEARTRADE NAME MODEL BODY TYPE IDENTIFICATION NUMBER SYM Way WeekMILEAGE W/C=Work/School;B=Business;F=Farm;P=PleasureThe Vehicle(s) described herein is principally garaged at the above address unless otherwise stated.* This policy provides ONLY those coverages where a premium is shown below. The limits shownmay be reduced by policy provisions and may not be combined regardless of the number ofvehicles for which a premium is listed unless specifically authorized elsewhere in this policy. VEH VEHVEHVEHCOVERAGESLIMITS OF LIABILITY ("ACV" MEANS ACTUAL CASH VALUE)D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT $AMOUNT $AMOUNT $AMOUNT $ V V V V E E E E H H H H In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas, on this date 5000 C 53383- PAGE 6 ADDL INFO ON NEXT PAGE MAIL MCH-M-I RENEWAL OF 04 06 00806 14 21CCA 249249 XX 7101 7 CALIFORNIA AUTO POLICY EFFECTIVE JAN 25 2025 TO JUL 25 2025RENEWAL DECLARATIONS OPERATORS(ATTACH TO PREVIOUS POLICY) 01 JAMES K TILLEY 03 HEATHER L TILLEY JAMES K TILLEY 04 15 NISSAN ALTIMA 2.5 4D 13000 1N4AL3AP4FC169119 P 06 22 KIA TELLURIDE 4D 12000 5XYP64HC5NG305160 P VEH 04 VISTA CA 92081-4500 VEH 06 VISTA CA 92081-4500 06 6-MONTH04 6-MONTH PART A - LIABILITY BODILY INJURY EA PER $ 100,000 EA ACC $ 300,000 146.41 148.03 PROPERTY DAMAGE EA ACC $ 50,000 76.38 82.62 PART B - MEDICAL PAYMENTS EA PER $ 5,000 9.03 7.61 EXTENDED BENEFITS WAGE EARNER DISAB $1,000 PER 30-DAY PERIOD ESSENTIAL SVCS DISAB $45 WK 1.93 1.93 PART C - UNINSURED MOTORISTS BODILY INJURY EA PER $ 100,000 EA ACC $ 300,000 60.42 59.80 WAIVER OF COLL DEDUCTIBLE 1.19 1.17 PART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 500 40.90D 500 49.89 COLLISION LOSS ACV LESS D 500 166.66D 500 314.96 TOTAL PREMIUM - SEE FOLLOWING PAGE(S) LOSS PAYEE VEH 04 NISSAN MOTOR ACCEPTANCE CORP, SACRAMENTO CA VEH 06 USAA FEDERAL SAVINGS BANK, LEHIGH VALLEY PA 1141211431 ENDORSEMENTS: ADDED 01-25-25 - NONE REMAIN IN EFFECT(REFER TO PREVIOUS POLICY)- A200CA(01) RSGPCW(01) 5100CA(02) INFORMATION FORMS: NIPFCA(05) 320CA(05) 50CA(05) CADS(05) 40CA(01) 13580(03) 999CA(20) 04 RMM34000N 06 RMF35000N DECEMBER 20, 2024 05-12 05-12 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 USAA CASUALTY INSURANCE COMPANY (A Stock Insurance Company)State Veh POLICY NUMBER 9800 Fredericksburg Road - San Antonio, Texas 78288 Terr POLICY PERIOD:(12:01 A.M. standard time) Named Insured and Address WORK/SCHOOLVEH USE *Description of Vehicle(s)Miles DaysANNUALOnePerVEHYEARBODY TYPEMODEL IDENTIFICATION NUMBER SYMTRADE NAME Way WeekMILEAGE The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated.W/C=Work/School;B=Business;F=Farm;P=Pleasure* This policy provides ONLY those coverages where a premium is shown below. The limits shown may be reduced by policy provisions and may not be combined regardless of the number ofvehicles for which a premium is listed unless specifically authorized elsewhere in this policy. VEH VEH VEH VEHCOVERAGESLIMITS OF LIABILITY ("ACV" MEANS ACTUAL CASH VALUE)D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT $AMOUNT $AMOUNT $AMOUNT $ V V V V E E E E H H H H In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas, on this date 5000 C 53383- PAGE 7 04 06 CA 249249 XX 00806 14 21C 7101 7 CALIFORNIA AUTO POLICY EFFECTIVE JAN 25 2025 TO JUL 25 2025RENEWAL DECLARATIONS (ATTACH TO PREVIOUS POLICY) JAMES K TILLEY 04 15 PNISSAN ALTIMA 2.5 4D 1N4AL3AP4FC16911913000 06 22 PKIA TELLURIDE 4D 5XYP64HC5NG30516012000 VEH 04 VISTA CA 92081-4500 VEH 06 VISTA CA 92081-4500 04 6-MONTH 06 6-MONTH PART D - PHYSICAL DAMAGE COVERAGE RENTAL REIMBURSEMENT STANDARD CLASS 28.38 28.38 ___________________________________________________________________________________ VEHICLE TOTAL PREMIUM 531.30 694.39 6 MONTH PREMIUM $ 1225.69 PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL, STATEMENT TO FOLLOW. CA FRAUD ASSESSMENT FEE $ 1.76 THE FOLLOWING COVERAGE(S) DEFINED IN THIS POLICY ARE NOT PROVIDED FOR: VEH 04 - TOWING AND LABOR VEH 06 - TOWING AND LABOR 04 RMM34000N 06 RMF35000N DECEMBER 20, 2024 05-12 05-12 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 SUPPLEMENTAL INFORMATION The following approximate premium discounts or credits have already been applied to reduce your policy premium costs. NOTE: Age or status, if allowed by your state/location, was taken into con sideration whensenior citizen your rates were set and your premiums have already been adjusted. SUPDECCW Rev. 7-95 PAGE 8 CIC 00806 14 21 7101 EFFECTIVE JAN 25 2025 TO JUL 25 2025 VEHICLE 04 GOOD DRIVER DISCOUNT -$ 132.82 OPERATOR 01 MULTI-CAR DISCOUNT -$ 93.41 MULTI-POLICY DISCOUNT -$ 51.13 ALL OTHER PROPERTY AND CASUALTY LINES, LIFE PASSIVE RESTRAINT DISCOUNT -$ 1.36 PERSISTENCY DISCOUNT -$ 101.27 PREMIER OPERATOR DISCOUNT -$ 143.46 VEHICLE 06 ANTI-THEFT DISCOUNT -$ 14.34 GOOD DRIVER DISCOUNT -$ 173.59 OPERATOR 03 MULTI-CAR DISCOUNT -$ 126.61 MULTI-POLICY DISCOUNT -$ 69.29 ALL OTHER PROPERTY AND CASUALTY LINES, LIFE PASSIVE RESTRAINT DISCOUNT -$ 1.18 PERSISTENCY DISCOUNT -$ 137.24 PREMIER OPERATOR DISCOUNT -$ 194.44 DECEMBER 20, 2024 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 9800 Fredericksburg Road San Antonio, Texas 78288 NOTICE OF INFORMATION PRACTICES This notice describes the information practices of the: United Services Automobile Association, USAA Casualty Insurance Company, USAA General Indemnity Company, and Garrison Property and Casualty Insurance Company. These practices relate to the information we have about you. You may have also received our "Privacy Promise." However, the laws in your state require that we give you this notice. Any other notice does not limit your rights in this notice. COLLECTION OF INFORMATION We collect information about you, and the individuals you add on your policy, from various sources. This data may be gathered from you and other sources by telephone, in person, electronically, or by mail. Some examples are shown below: Information you provide on applications and other forms, such as name, address, and date of birth. Information about your transactions with us, or with other companies. This means, for example, a request for a new policy, a policy change, or a billing transaction. Information from consumer reporting agencies, such as a motor vehicle report. Data from research firms and other data providers. Information gathered during the process of handling insurance claims, including health information. Information from government agencies, such as accident or theft reports. SHARING OF INFORMATION AS PERMITTED BY LAW We may need to share some information about our current or former customers outside of USAA to properly manage our business. This includes sharing to efficiently service your accounts, to comply with laws, and for other routine business practices. For example, we may share such information with: You, when handling your insurance transactions. Our affiliates. Businesses that provide information to us or assist in settling claims. This may involve other insurers, medical care institutions or professionals, or repair shops. Regulatory, law enforcement, or other government agencies. Those who provide us a business service or help us with an insurance function, such as printers, mail houses, appraisers, or insurance support organizations. Those who assist us in detecting or preventing criminal activity, fraud, material misrepresentation, or material nondisclosure in connection with an insurance transaction. Those who serve us with a facially valid administrative or judicial order, including a search warrant or subpoena. Those who conduct actuarial or research studies. IMPORTANT PRIVACY CHOICES USAA provides two privacy opt out choices: (1) limit the information USAA uses for marketing and (2) limit the flow of information within USAA. You may opt out online by updating your Privacy Preferences at usaa.com/optout, or by calling us at (800) 531-7154. Opting out will make it difficult for us to serve you as you might expect. If you opt out: We may need you to repeat information that you have already provided and we may not be able to pre-fill applications for you. We may have to transfer your phone calls more often. We may not have information that allows us to offer you the products that best meet your needs. 50873-0114_01 NIP-F-CA(05) Rev. 01-14 Page 1 of 2 PAGE 9 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 AUTHORIZATION TO SHARE We honor any additional rights you may have under state laws. By not opting out, you authorize us to use and share your information within USAA. SECURITY AND CONFIDENTIALITY PRACTICES USAA protects the information we collect. Access to this information is limited to those persons who must have it to do their jobs. We also have: Physical security at our buildings. Password protected databases and virus/intrusion detection software. Privacy compliance audits. INFORMATION FOR INTERNET USERS USAA uses Internet cookies and related technology for your security, to manage our site and to provide more relevant offers. Visit our Security Center at usaa.com to learn more. USAA collects personal information on USAA websites, web pages and "apps", as well as public information posted on social media, for site management, security, business and marketing purposes. Examples of information we may collect include: previous URL you visited, transaction information you submit, and clicks on USAA ads and related pages. REVIEWING AND CORRECTING PERSONAL INFORMATION You may review our files of personal information about you. You may do this in person or request a copy. We are not required to provide information that relates to any claim, whether paid or not, or when the possibility of a lawsuit reasonably exists. The review request must: Be in writing. Specify the type of personal information you wish to review. Include your name, address, and policy number. Be mailed to: USAA, 9800 Fredericksburg Road, San Antonio, Texas 78288-0342 After we receive your request, we will: Inform you of the nature of the information we have. Confirm if the data you are requesting is available. Advise you of processing and copy fees. These fees are due before we provide any copies you request. If you request medical information supplied by a medical care institution or professional, we will release the information to you and tell you the source of the information. If you direct us, we will release copies of this information to the licensed medical professional you designate. Mental health information may be supplied to you only with the approval of a qualified professional with treatment responsibility for the condition to which the information relates. You may also request that we correct, amend, or delete incorrect personal information we have about you. This request must: Be made to us in writing. Be made separate from a review request. Explain what you believe is incorrect and why. Be mailed to the address given above. INSURANCE SUPPORT ORGANIZATIONS AND THE INFORMATION RETAINED Insurance support organizations may keep information they give us. These firms may share that information with other persons as permitted by law. NIP-F-CA(05) Rev. 01-14 Page 2 of 2 PAGE 10 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 COMPLAINT NOTICE Should any dispute arise about your premium or about a claim that you have filed, write or call us. The information shown below applies to the company displayed on the declaration page. usaa.com 9800 Fredericksburg Rd. San Antonio, Texas 78288 (800) 531-USAA (8722) The Department of Insurance should only be contacted if the problem cannot be resolved. You may write or call the Department of Insurance at: www.insurance.ca.gov California Department of Insurance Consumer Services Division 300 S. Spring Street Los Angeles, California 90013 (800) 927-HELP (4357) 55207-1016 320CA(05) Rev. 10-16 Page 1 of 1 PAGE 11 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 Important Information About Changes to Your Auto Policy Below you will find a brief outline of changes we have made to your auto policy. This is meant to give you a general understanding of these changes. This form does not provide any coverage, and it does not replace any of the provisions of your policy. For details, please read the policy and endorsements in this renewal packet. If there is a conflict between the policy and this summary, the provisions of the policy apply. You may review your policy online at usaa.com. If you have questions, please call 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722. Changes to Your Auto Policy Coverage Prior Policy New Policy Notes Liability - Other Insurance California Auto minimum Bodily Injury liability limits are $15,000 per person/$30,000 per accident and Property Damage liability limit is $5,000 per accident California Auto minimum Bodily Injury liability limits are $30,000 per person/$60,000 per accident and Property Damage liability limit is $15,000 per accident. If applicable, limits have been increased to $30,000 per person/$60,000 per accident and Property Damage liability limit is $15,000 per accident. Please see Declarations Page for current coverage limits. Uninsured/Underinsured Motorist - Other Insurance Underinsured Motorist Liability limits was available in limits as low as $15,000 per person/$30,000 per accident. Limits lower than $30,000 per person/$60,000 per accident are no longer available. If applicable, limits have been increased to $30,000 per person/$60,000 per accident. Please see Declarations Page for current coverage limits. 56904-0724_01 50CA(05) Rev. 07-24 Page 1 of 1 PAGE 12 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 INFORMATION USED TO DETERMINE YOUR PREMIUM IN CALIFORNIA This information is designed to help you understand the factors we use to determine the premiums you pay for each private passenger vehicle we insure and to make you aware of all the discounts we offer. There is also an explanation of the Classification Code you see on your Declarations Page. Factor Explanation of factor Driving experience The number of years a driver has been licensed to drive. Location Where you garage your vehicle. Vehicle type The year, make and model of the vehicle, as well as its safety and security features. Vehicle use How the vehicle is used (i.e., business, farm, or other) and the total miles driven annually. Financial Responsibility Surcharge An additional premium charged when we must file a certificate of financial responsibility with the state at your request. Chargeable incidents The rating plan we submitted to the California Department of Insurance allows us to consider convictions and at-fault accidents when determining your premium. We may charge additional premium for incidents accumulated within three years of the policy issue or renewal date. These chargeable incidents affect the premiums for the major coverages displayed on the Declarations page. Conviction - A moving motor vehicle conviction. At-fault accident - An accident for which the driver is 51% or more legally responsible and the accident outcome included a fatality, bodily injuries and/or property and/or collision damage in excess of $1,000. Discounts Discounts apply to your vehicle and/or the insured drivers in the household. 64330-0919_01 CADS(05) Rev. 03-20 Page 1 of 4 PAGE 13 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 DISCOUNTS We will automatically include all discounts that we know apply to your vehicle and the insured drivers in the household. Your discounts are listed on the Supplemental Information page attached to your policy. The following discounts are available. Discount Is offered... Anti-theft When your vehicle is equipped with a vehicle recovery system (a system that emits a signal when activated). Away at School When a driver is an occasional operator with less than 14 years driving experience, is a full-time student and resides more than 100 miles away from home without a vehicle. Driver Training To drivers with less than three years of driving experience who successfully completed an approved driver training course. Good Student To drivers with fewer than nine years driving experience who are full-time students maintaining at least a 3.0 or a "B" average. Good Driver To drivers who have both of the following: A three year history of: Continuous licensing, No more than one traffic conviction or at-fault accident with physical damages exceeding $1,000 and No at-fault accidents involving bodily injuries exceeding $1,000 or a fatality. A 10-year history of no convictions for driving under the influence of alcohol and/or drugs. If a driver no longer qualifies for the Good Driver Discount, you may exclude the driver from coverage. Mature Driver Improvement Course To principal drivers, age 55 or older, who successfully complete a mature driver improvement course approved by the California Department of Motor Vehicles. We'll need a copy of the completion certificate to apply the discount. The discount renews automatically for three years after the course completion date if the driver has no at-fault accidents or convictions. Military Installation Garaging When a vehicle is garaged on a military installation. Multi-Car When we insure two or more eligible vehicles on the same policy. Multi-Policy When you have other policies (non-auto) in effect with us when your auto policy is issued or renewed. New Vehicle When your vehicle is no more than three years old. For the purpose of this discount, a vehicle ages as of Oct. 1 of the current year. Occasional Operator To an insured driver who is neither the owner nor principal driver of any one vehicle. CADS(05) Rev. 03-20 Page 2 of 4 PAGE 14 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 Passive Restraint Device When your vehicle is equipped with airbag(s) and/or automatic seatbelts. Persistency Based on the number of years you have continuously maintained an active auto policy with us. Premier Operator To an insured driver who has at least five years driving experience, qualifies for the Good Driver Discount and has neither an at-fault accident nor major conviction within the previous five years. Storage Discount When your vehicle is being stored in a secure location and you, or others, will not drive the vehicle. Vehicle Injury When a vehicle from model years 1985 to 1997 has significantly better than average personal injury loss experience. Note: An additional charge may apply to vehicles with significantly worse than average experience. Explanation of Classification Codes On the bottom of your Declarations page, you will see a box similar to the example below. The alpha or numeric characters in the bottom line of the box are codes that reflect information used to determine the premium for the major coverages: Liability, Medical Payments, Comprehensive, Collision, Uninsured Motorists Bodily Injury, Uninsured Motorists Property Damage and Uninsured Motorists Property Damage Waiver of Collision Deductible. The following example and explanation will help you understand the codes. V E H 01 RSM25 000 N This code means vehicle 01 is located in your state of primary residence and the rated driver is a single male, licensed 25 years with zero accidents or convictions, and no financial responsibility surcharge. Gender is not used in rating. CLASSIFICATION CODES Character Symbol Means... st 1 R This vehicle is located in your state of primary residence. A This vehicle is located in a state other than your primary residence. L This vehicle is located in your state of primary residence, and the driver associated with it has a learner's permit. nd 2 M Married S Single rd 3 M, F, U, or X Indicates gender but it is not used in rating. th th 4 and 5 ##Number of years licensed to drive. th th 6 -8 ###The first digit indicates the number of accidents and the other two are the number of points assigned for moving traffic violations. Note: An "A" in the first position means there are more than 10 accidents. th 9 Y or N Indicates whether there is a financial responsibility surcharge. CADS(05) Rev. 03-20 Page 3 of 4 PAGE 15 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 Exception Codes for characters 1-5: Code Appears when... XXX99 The vehicle is located in your state of primary residence, there are more vehicles than drivers and all licensed drivers on the policy are already associated with other vehicles. If you have questions, please call us at 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722. CADS(05) Rev. 03-20 Page 4 of 4 PAGE 16 CIC 00806 14 21 7101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 CA Third-Party Designee Notice You are entitled to designate another person to receive any termination, expiration, nonrenewal cancellation notice involving this California insurance policy. Such notifications will be made to the designee in addition to any notifications made to you, the named insured. To make a third-party designation, you must provide us with your written authorization, as well as written acknowledgement by your designee. If you would like to appoint a designee, please become familiar with the following stipulations and review them with the designated person: The appointment of a designee will apply to your automobile, homeowners, rental property insurance or renters policies. Your designee is only authorized to receive copies of notices of policy cancellations or non-renewals. All other correspondence between you and USAA will remain confidential. Your designee will have no authority to act on your behalf to make any policy changes or conduct any other business involving your account. If you would like to authorize someone to handle your account and policies, please let us know. We can arrange that with a power of attorney. Your designee will incur no liability by accepting this designation by you. You may discontinue the appointment of the designee at any time by notifying us in writing. We recommend that you advise your designee of these types of changes, since we will not send your designee any notice. You may appoint another designee by following the same process you used to appoint your first designee. To appoint a designee, provide us with your request on the enclosed form. If you have any additional questions about making a third-party designation, please call us at 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722. 129510-1015 40CA(01) 01-16 Page 1 of 2 PAGE 17 CIC 00806 14 21 7101 PS.008061421.40CA.07101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 Request for Appointment of Third-Party Insurance Notification Designee Member Name USAA Member Number Member Address The following designee is authorized to receive a separate copy of any notices of cancellation or non-renewal of my auto and or homeowners (RPI) policies. Designee Name Designee Mailing Address (for Notices) DateMember's Signature I accept this appointment to be an insurance notification designee for the member named above. I understand that I will be sent copies of any cancellation or non-renewal of the auto, homeowners, rental property insurance and renters policies of the above member. Additionally, I do not incur any liability by accepting this appointment. DateDesignee's Signature Mail to: USAA 9800 Fredericksburg Rd San Antonio, TX 78288 Both parties must sign where indicated. 40CA(01) 01-16 Page 2 of 2 PAGE 18 CIC 00806 14 21 7101 PS.008061421.40CA.07101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 Reasons for a Policy Premium Increase, Cancellation, or Nonrenewal The following table lists specific reasons we would increase premiums, nonrenew, or cancel automobile policies in California. Action Reasons Premium Change in: increase Vehicle. Vehicle location. Vehicle use. Driver. Addition or deletion of a vehicle or driver. Loss of a premium discount or credit. Premium An insured driver on the policy was: increase or Primarily responsible for an accident and the insurer nonrenewal paid a claim for bodily injury, property and/or collision damage in excess of the state's dollar threshold. Convicted of violating any provision of the Vehicle Code or Penal Code involving the operation of a motor vehicle. Any reason not stated that is both lawful and not unfairly discriminatory. Cancellation or Non-payment of premium. nonrenewal Suspended or revoked driver's license.. Fraudulent claim. Material misrepresentation of rating or underwriting information. Substantial Increase in the risk of hazard. 13580(03) Rev. 11-07 13580-1107 PAGE 19 CIC 00806 14 21 7101Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 CALIFORNIA UNINSURED MOTORISTS COVERAGES UNINSURED MOTORISTS BODILY INJURY COVERAGE Below you will find a brief explanation of Uninsured Motorists Bodily Injury Coverage in California. This explanation is only an overview, and it does not replace or supplement any of the provisions of your policy. Please see your policy for details because the policy controls all issues of coverage. If you have questions or want to discuss or increase your limits, please call us at 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722. You can complete this form online at usaa.com. Rejection of Uninsured Motorists Bodily Injury Coverage The California Insurance Code requires an insurer to provide uninsured motorists coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to delete the coverage when a motor vehicle is operated by a natural person or persons designated by name. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, that the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. Uninsured motor coverage does not provide any insurance with respect to a vehicle you do not own if the owner of that vehicle has similar insurance. An uninsured motor vehicle includes an unidentified hit-and-run vehicle, or an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code. Uninsured Motorists Bodily Injury Coverage pays if you are injured by an at fault motorist whose Bodily Injury Liability limits are less than your Uninsured Motorists Bodily Injury Coverage limits and less than the amount of damages you are legally entitled to recover from that at-fault motorist. The at-fault motorist's policy pays its Bodily Injury Liability limits first, then your Uninsured Motorists Bodily Injury Coverage pays the lesser of: any remaining loss, or the difference between the driver's Bodily Injury Liability and your Uninsured Motorists Bodily Injury Coverage limits. TO REJECT UNINSURED MOTORISTS BODILY INJURY COVERAGE, COMPLETE THE REJECTION SECTION ON THE ATTACHED REJECTION/SELECTION FORM OR COMPLETE THIS FORM ON USAA.COM. Reduction of Uninsured Motorists Bodily Injury Coverage The California Insurance Code requires an insurer to provide uninsured motorists coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to agree to provide coverage in an amount less than that required by subdivision (m) of Section 11580.2 of the Insurance Code, but not less than the financial responsibility requirements of $30,000/$60,000. 56298-0824_01 999CA(20) Rev. 08-24 Page 1 of 4 PAGE 20 CIC 00806 14 21 7101 PS.008061421.40CA.07101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, that the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. Uninsured motorists coverage does not provide any insurance with respect to a vehicle you do not own if the owner of that vehicle has similar insurance. An uninsured motor vehicle includes an unidentified hit-and-run vehicle, or an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code. Uninsured Motorists Bodily Injury coverage pays if you are injured by an at-fault motorist whose Bodily Injury Liability limits are less than your Uninsured Motorists Bodily Injury limits and less than the amount of damages you are legally entitled to recover from the at-fault motorist. The at-fault motorist's policy pays its Bodily Injury Liability limits first, then your Uninsured Motorists Bodily Injury Coverage pays the lesser of: any remaining loss, or the difference between the driver's Bodily Injury Liability limits and your Uninsured Motorists Bodily Injury Coverage limits. 999CA(20) Rev. 08-24 Page 2 of 4 PAGE 21 CIC 00806 14 21 7101 PS.008061421.40CA.07101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 REJECTION OF UNINSURED MOTORIST COVERAGE LIMIT Complete this section of the form only if you want to reject Uninsured Motorists Coverage entirely for this policy. If you do not want to reject Uninsured Motorist Coverage, no action is required. I reject Uninsured Motorists Bodily Injury Coverage for this policy and all subsequent renewals until I request otherwise. I understand that I cannot have Uninsured Motorists Property Damage Coverage if I reject Uninsured Motorists Bodily Injury. Please read this form carefully before you sign. By signing this form, you agree that you have read and understand this information. FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT INFORMATION TO OBTAIN OR AMEND INSURANCE COVERAGE OR TO MAKE A CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. DateUSAA Number Signature of Named Insured IF YOU HAVE REJECTED UNINSURED MOTORIST COVERAGE ENTIRELY IN THE SECTION ABOVE, NO FURTHER ACTION IS REQUIRED. PLEASE RETURN THIS FORM TO USAA. If this form is sent by fax machine or other electronic means, the sender adopts the document received by USAA as a duplicate original and adopts the signature received by USAA as the sender's original signature. You can return this form to: Mail:USAA 9800 Fredericksburg Road San Antonio, TX 78288 Fax:210-531-8877 or 800-531-8877 Online:usaa.com 999CA(20) Rev. 08-24 Page 3 of 4 PAGE 22 CIC 00806 14 21 7101 PS.008061421.40CA.07101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527 THIS PAGE INTENTIONALLY LEFT BLANK 999CA(20) Rev. 08-24 Page 4 of 4 LAST PAGE 23 CIC 00806 14 21 7101 PS.008061421.40CA.07101 Docusign Envelope ID: 29A95645-CC69-408D-A82C-08A037B54527