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HomeMy WebLinkAboutAlliance Environmental Group LLC; 2019-10-24; PWL20-914GS.. RECORDED REQUESTED BY CITY OF CARLSBAD DOC# 2019-0586251 I llllll lllll lllll 111111111111111 lllll lllll 1111111111111111111111111111 Dec 16, 2019 01 :46 PM OFFICIAL RECORDS Ernest ,I Dronen burg, Jr , AND WHEN RECORDED PLEASE MAIL TO: SAN DIEGO COUNTY RECORDER FEES $0.00 (SB2 Atkins $0.00) City Clerk City of Carlsbad 1200 Carlsbad Village Drive Carlsbad, California 92008 PAGES. 1 Space above this line for Recorder's use. PARCEL NO: NOTICE OF COMPLETION Notice is hereby given that: 205-111-27-00 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full names of the undersigned are City of Carlsbad, a municipal corporation. 3. The full address of the undersigned is 1200 Carlsbad Village Drive, Carlsbad, California 92008. 4. The nature of the title of the undersigned is: In fee. 5. A work or improvement on the property hereinafter described was completed on Sept. 27, 2019. 6. The name of the contractor for such work or improvement is Alliance Environmental Group, LLC. 7. The property on which said work or improvement was completed is in the City of Carlsbad, County of San Diego, State of California, and is described as follows: Project No. PWL -14GS, Project Name: Urgent Scout House Asbestos Abatement -Ratification. 8. The street address of said property is 3225 Eureka Pl, Carlsba CA 92 08, in the City of Carlsbad. VERIFICATION OF CITY CLERK I, the undersigned, say: I am the City Clerk of the City of Carlsbad, 1200 Carlsbad Village Drive, Carlsbad, California, 92008; the City Manager of said City on Norembec a,+A , 20.l.!1_, accepted the above described work as completed and ordered that a Notice of Completion be filed. I declare under penalty of perjury that the foregoing is true and correct. Executed on Dtcem,eC q+A, 20_1i, at Carlsbad, California. CITY OF CARLSBAD -{,,1 ~l:J£d.rL ~f'lti! I Dtp"!:) BARBARA ENGLESON C rl/1 City Clerk J IIFILES01V\Departments\Public Works\General Services\Agreements & Contracts\Alliance Environmental Group, LLC\Urgent Scout House Asbestos Abatement -Ratification -PWL20-914GSl3. NOC\2.NOC -Urgent Scout House Asbestos Abatement.docx CletJ<' CITY OF CARLSBAD ACCEPTANCE OF PUBLIC IMPROVEMENTS COMPLETION OF PUBLIC IMPROVEMENTS Alliance Environmental Group, LLC. has completed the contract work required for PWL20-914GS -Urgent Scout House Asbestos Abatement -Ratification. City forces have inspected the work and found it to be satisfactory. The work consisted of: IMPROVEMENTS Remove asbestos containing materials in a storage closet and stage area. VALUE $4,620.00 CERTIFICATION OF COMPLETION OF IMPROVEMENTS ~ (\ Jt-7~1s, John ~WoW<s'Manager Date CITY MANAGER'S ACCEPTANCE OF PUBLIC IMPROVEMENTS The construction of the above described contract is deemed complete and hereby accepted. The City Clerk is hereby authorized to record the Notice of Completion and release the bonds in accor ce with State Law and City Ordinances. The is hereby directed to commence maintaining the above described Date APPROVED AS TO FORM: CELIA BREWER, City Attorney \\FILES01V\Departments\Public Works\General Services\Agreements & Contracts\Alliance Environmental Group, LLC\Urgent Scout House Asbestos Abatement -Ratification - PWL20-914GS\3. NOC\3.API -Urgent Scout House Asbestos Abatement.docx PWL20-914GS CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT URGENT SCOUT HOUSE ASBESTOS ABATEMENT: CONTRACT 4709 This RATIFICATION OF LETTER OF AGREEMENT between Alliance Environmental Group, LLC., a limited liability com~ (Contractor) and the City of Carlsbad (City) is entered into as of the f) t./tp. day of b be!:z_, , 2019, but effective as of September 18, 2019, ratifying the work performed for the Urgent Scout House Asbestos Abatement. The Contractor provided all equipment, material and labor necessary to remove asbestos containing materials in a storage closet and stage area, per Exhibit "A" and City specifications, for a sum not to exceed four thousand six hundred twenty dollars ($4,620). This work was completed within three (3) working days after the Notice to Proceed was issued. Upon full execution, the Letter of Agreement is ratified. ADDITIONAL REQUIREMENTS 1. City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees, and volunteers from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers' Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Insurance is to be placed with California admitted insurers that 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. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4 California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims ':h :3°vern_m_ent ~section~ _12650, et seq .. and Carlsbad Municipal Code Sections 3.32.025, et seq. ~ Irnt mIt 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. Jv/f'T init ~ init Urgent Scout House Asbestos Abatement; Contract No. 4709 - 1 -City Attorney Approved 2/29/2016 PWL20-914GS 7. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. 8. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of applicable wage rates is on file in the office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in the execution of the work covered by this Letter of Agreement. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 9. City Contact: Brian Bacardi 760-434-2944 Contractor Contact: Andrew Grabhorn 626-633-3500 CONTRACTOR Alliance Environmental Group, LLC, a limited liability company 990 W. 10th Street Azuza, CA 91702 P: 626-633-3500 F: 626-633-3599 AndrewGrabhorn@alliance-enviro.com By: ~~'~ (signher :h},I) w. rVl t (e4,-J J"L C.tu (print name/title) By: ~h~/(4'5/ ~name/title) ' CITY OF CARLSBAD, a municipal corporation of the State of California By: Dated: (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. 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: CELIA A. BREWER, City Attorney BY~/ DeputyCrtyA~y Urgent Scout House Asbestos Abatement; Contract No. 4709 -2 -City Attorney Approved 2/29/2016 PWL20-914GS EXHIBIT A Urgent Scout House Asbestos Abatement Contractor provided all material, tools and labor to remove all asbestos containing material in the storage closet and stage area of the Scout House located at 3225 Eureka Place, Carlsbad CA 92008. All work shall be performed in accordance with all Federal, State and Local laws. The scope of work consisted of: Isolating the storage and stage areas by constructing a containment barrier. Setting up a decontamination system adjacent to the work area. Running negative air filtration during the abatement and monitoring the air in the work areas. Removing and disposing of carpeting and partition wall atop subfloor, wood subfloor, and asbestos containing tile and mastic in stage area. Removing and disposing of asbestos containing floor tile in the storage room. Upon successful clearance testing from a third party, removing containment and equipment. SCOPE OF WORK AND FEE DESCRIPTION PRICE Asbeatos abatement of the storage and stage areas of the Scout $4,620 House. *Includes taxes, fees, expenses and all other costs. Urgent Scout House Asbestos Abatement; Contract No. 4709 - 3 - TOTAL $4,620 City Attorney Approved 2/29/2016 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validi of that document. State of California County of ____ -1""-"""'="<-.....a._._,__""T"'-o-'t---"-=--' I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. J ft ft ft ft ft ft ft ft ft ft ft ft ~ o,, RAMONA F. BOSTIC ~ ~ '_ Notary Pdil,c Cal1forn1a < ~ ' ., ~ -, Los A~~P1es County ;, " Comnw,'>1an # 2234759 - , ... My Corr:-r Ex;J1'es Mar 18. 2022 (Seal) ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validi of that document. State of California County of ___ ,,__~._L.-1-u...;::~~~'--- I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. iftftftftftftftftftftftftf ._~. ~'.., RAMO"'IA F. BOSTIC : ~. Notnev Pc,lil,c (al•focn,,, ✓• ✓ •~;t-e.•r ~:.:, Lo'> ~\:-'~PIP'> County ~ ~ ~f:1 Cnc"rn•w,w" /2347.59 ~ ~My(ClrT"T UJl't",Md' 18 2C22 --.. (Seal) ACORD0 CERTIFICATE OF LIABILITY INSURANCE 1/29/2020 I DATE (MM/00/YYYY) ~ I 0/1/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LOCKTON COMPANIES l:il.':l1t"' 3657 BRIARPARK DRIVE, SUITE 700 Wc."tro Ext): I r..oe Nol: Houston TX 77042 E-MAIL ADDRESS: ···-.. --..,,c:a a••nR□1Nr. --NAIC# INSURER A: Starr Surplus Lines Insurance Company 13604 INSURED Alliance Environmental Group, LLC INSURER B: Starr Indemnity & Liabilitv Company 38318 1444909 990 West Tenth Street INSURERC: Azusa CA 91702 '"'""RER D· IN<:IIRER E · INSURER F: COVERAGES CERTIFICATE NUMBER· 16335159 REVISION NUMBER· XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AOOL ~ POLICY NUMBER 11~~fo)#fv1 POLICY EXP LIMITS LTR INS0 A .x. COMMERCIAL GENERAL LIABILITY y y 1000065722191 6/10/2019 6/10/2020 EACH OCCURRENCE $ 1 000,000 D CLAIMS-MADE [xJ OCCUR ~~~~~il9E~~~J~r?ence\ $ 300,000 MED EXP (Anv one person) $ 50 000 -PERSONAL & ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 1 [x]PRO-□LOG $ 2,000,000 POLICY JECT PRODUCTS -COMP/OP AGG OTHER: $ B AUTOMOBILE LIABILITY -y y SISIPCA082644 l 9 6/10/2019 6/10/2020 1=~~~b~d~~trlNGLE LIMIT $ 1.000 000 .x. ANY AUTO BODILY INJURY (Per person) $ xxxxxxx -OWNED SCHEDULED BODILY INJURY (Per accident $ xxxxxxx -AUTOS ONLY -AUTOS HIRED NON-OWNED Pp~?~&:~Je~t?AMAGE $ xxxxxxx -AUTOS ONLY -AUTOS ONLY X Comp&Coll Medical Pav $ 5,000 UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ xxxxxxx ,__ NOT APPLICABLE EXCESS LIAB CLAIMS-MADE AGGREGATE $ xxxxxxx OED I I RETENTION$ $ B WORKERS COMPENSATION y 100 0002615 03 1/29/2019 1/29/2020 X IHfTUTE I jOTH-ANO EMPLOYERS' LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE [ill N/A E.L. EACH ACCIDENT $ I 000 000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ I 000 000 ~l;t~rt.rii~ ~:~PERATIONS below E.L. DISEASE· POLICY LIMIT 1 1 000 000 A Contractors Pollution y y 1000065722191 6/10/2019 6/10/2020 Per Occll!Tence: $1,000,000 Aggregate: $2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Additional insured in favor of The City of Carlsbad on all policies (except Workers' Compensation/El) where and to the extent required by written contract. CERTIFICATE HOLDER 16335159 City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 4668 -ECM #35050 New York NY 10163-4668 ACORD 25 (2016/03) CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATI . All rights reserved The ACORD name and logo are registered marks of ACORD ./ I Attachment Code : D544488 Master ID: 1444909, Certificate ID: I 6335159 Professional Liability Policy No.: 1000065722191 Policy Term: 6/10/2019 -6/10/2020 Insurer: Starr Surplus Lines Insurance Company Limits: $1,000,000 Each Claim $1,000,000 Aggregate Attachment Code: D543064 Master ID: 1444909, Certificate ID: 16335159 • Starr Surplus Lines Insurance Company Chicago, IL 1-646-227-6300 Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number: 1000065722191 Effective Date: 6/10/2019 at 12:01 A.M. Named Insured: Alliance Environmental Holdings, LLC This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage Form Products/Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE Where Required By Written Contract A. SECTION II -WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of "your work" for that insured by or for you. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage" arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insured's shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured's because of payments we make for injury or damage arising out of "your work" done under a written contract with the additional insured. 3. The term insured is used separately and not collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. All other terms and conditions of this Policy remain unchanged. Signed for STARR SURPLUS LINES INSURANCE COMPANY ounsel SL 023 (06/11) Page 1 of 1 Copyright© C. V. Starr & Company and Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Attachment Code : D543996 Master ID: I 444909, Certificate ID: 16335159 POLICY NUMBER: 1000065722191 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Location(s) Of Covered Operations Organization(s): Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 8. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "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 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Attachment Code: D543997 Master ID: 1444909, Certificate ID: 16335159 POLICY NUMBER: 1000065722191 COMMERCIAL GENERAL LIABILITY CG20370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Location And Description Of Completed Organization(s): Operations Where Required By Written Contract Where Required By Written Contract Information reauired to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Attachment Code : D543060 Master ID: 1444909, Certificate ID: 16335159 • Starr Indemnity & Liability Company Dallas. TX 1-866-519-2522 Additional Insured -Where Required Under Written Contract or Written Agreement Endorsement Policy Number: SISIPCA08264419 Effective Date: 6/10/2019 at 12:01 A.M. Named Insured: Alliance Environmental Holdings, LLC This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the declarations page. Please read the endorsement and respective policy(ies) carefully. Business Auto Coverage Form THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It is hereby agreed that SECTION II -COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, is amended to include the following: d. Any person or organization whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said written contract or written agreement. All other terms and conditions of this Policy remain unchanged. Steve Blakey, President and" Chief Executive Officer Nehemiah E. Ginsburg, General Coillisel SICA 1016 (04/14) Page I of I Copyright© Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Attachment Code : D544287 Master ID: 1444909, Certificate ID: 16335159 POLICY NUMBER: SISIPCA08264419 COMMERCIAL AUTO CA 04 4410 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Alliance Environmental Holdings, LLC Endorsement Effective Date: 6/10/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): Blanket where required by a written contract. Information reauired to comolete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 4410 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Attachment Code : D544681 Master ID: 1444909, Certificate ID: 16335159 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 00 0313 (Ed. 04-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We v not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 1/29/2019 Insured: Alliance Environmental Holdings, LLC Insurance Company: WC 00 0313 (Ed. 04-84) Policy No.: 100 0002615 03 Premium: Countersigned by: Endorsement No.: Page 1 of 1 Attachment Code: D544681 Master ID: 1444909, Certificate ID: 16335159 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy We w.ill not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 • 0% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Where required by contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 1/29/2019 Policy No.:100 0002615 03 Endorsement No.: Insured: Alliance Environmental Holdings, LLC Insurance Company: WC 04 03 06 (Ed. 04-84) Premium: Countersigned by: Page 1 of 1